• Tom Inglis, Dan Banaszek, Carly S Rivers, Dilnur Kurban, Nathan Evaniew, Nader Fallah, Zeina Waheed, Sean Christie, Richard Fox, ThiongJean-Marc MacJMDepartment of Surgery, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada., Karen Ethans, Chester Ho, Angelo Gary Linassi, Henry Ahn, Najmedden Attabib, Christopher S Bailey, Michael G Fehlings, Daryl R Fourney, Jérôme Paquet, Andrea Townson, Eve Tsai, Christiana L Cheng, Vanessa K Noonan, Marcel F Dvorak, and Brian K Kwon.
• Department of Orthopaedics, Vancouver Spine Surgery Institute, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
• J. Neurotrauma. 2020 Nov 1; 37 (21): 2332-2342.

AbstractAs the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are increasingly faced with difficult discussions regarding aggressiveness of management, likelihood of recovery, and survival. Our objective was to outline risk factors associated with in-hospital mortality in elderly surgical and non-surgical patients following tSCI and to determine those unlikely to have a favorable outcome. Data from elderly patients (≥ 65 years of age) in the Canadian Rick Hansen SCI Registry from 2004 to 2017 were analyzed using descriptive analysis. Survival and mortality groups in each of the surgical and non-surgical group were compared to explore factors associated with in-hospital mortality and their impact, using logistical regression. Of 1340 elderly patients, 1018 had surgical data with 826 having had surgery. In the surgical group, the median time to death post-injury was 30 days with 75% dying within 50 days compared with 7 days and 20 days, respectively, in the non-surgical group. Significant predictors for in-hospital mortality following surgery are age, comorbidities, neurological injury severity (American Spinal Injury Association [ASIA] Impairment Scale [AIS]), and ventilation status. The odds of dying 50 days post-surgery are six times higher for patients ≥77 years of age versus those 65-76 years of age, five times higher for those with AIS A versus those with AIS B/C/D, and seven times higher for those who are ventilator dependent. An expected probability of dying within 50 days post-surgery was determined using these results. In-hospital mortality in the elderly after tSCI is high. The trend with age and time to death and the significant predictors of mortality identified in this study can be used to inform clinical decision making and discussions with patients and their families.

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