Impact of Patient Age on Morbidity and Mortality in Adults with Acute Traumatic Cervical Spinal Cord Injury

Introduction: Traumatic spinal cord injury (SCI) rates have historically been higher in young patients, however the proportion of elderly patients presenting with acute SCI has been increasing. The aim of this study was to assess associations between age and adverse events (AEs), non-routine discharge, and in-hospital mortality in patients with acute cervical SCI.

Methods: We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Programs (TQP) database to compare outcomes for adult patients with acute cervical SCI based on age groups: 18-44 years, 45-65 years, and >65 years. Patient demographics, comorbidities, type of injury, treatment modality, AEs, length of stay (LOS) were assessed. Multivariate logistic regression was used to identify independent predictors of adverse events, non-routine discharge, and in-hospital mortality.

Results: Of the 71,048 patients identified, 19,838 (27.9%) patients were 18-44 years, 26,888 (37.8%) patients were 45-65 years, and 24,322 (34.2%) patients were >65 years of age. The proportion of patients sustaining SCI from fall significantly increased with increasing age (18-44 years: 21.7% vs. 45-65 years: 47.1% vs. >65 years: 71.9%, p< 0.001). Patients > 65 years of age had significantly greater rates of non-routine discharge (18-44 years: 64.5% vs. 45-65 years: 70.4% vs. >65 years: 87.0%, p< 0.001) and in-hospital mortality (18-44 years: 9.1% vs. 45-65 years: 8.3% vs. >65 years: 19.4%, p< 0.001) compared to the other cohorts. Conversely, mean LOS decreased significantly with increasing age (18-44 years: 14.3 ± 19.1 days vs. 45-65 years: 12.7 ± 16.8 days vs. >65 years: 10.5 ± 10.9 days, p< 0.001). On multivariate analysis, 45-65 years and >65 years age groups, respectively, significantly predicted any AE [OR:1.18, CI: 1.07-1.29, p< 0.001; OR:1.27, CI: 1.15-1.41, p< 0.001], non-routine discharge [OR:1.38, CI: 1.26-1.51, p< 0.001; OR:3.24, CI: 2.87-3.65, p< 0.001], and in-hospital mortality [OR:1.89, CI: 1.67-2.14, p< 0.001; OR:4.80, CI: 4.20-5.48, p< 0.001].

Conclusion : Our study suggests that older age is associated with increased morbidity and mortality risk in patients with acute cervical SCI. Additional research is needed to determine what factors contribute to these adverse outcomes in older SCI patients.