Perioperative Complications and Mortality Following Anterior Odontoid Screw Fixation in Elderly Patients

A National Database Analysis

Michael Longo, Yaroslav Gelfand, Rafael De la Garza Ramos, Murray Echt, Merritt D. Kinon, V. Yanamadala, Reza Yassari

Research output: Contribution to journalArticle

Abstract

Objective: To identify predictors of short-term mortality and complications after anterior odontoid screw fixation. Methods: This was a retrospective analysis of a national database. The American College of Surgeons National Quality Improvement Database was queried using Current Procedural Terminology codes to identify patients aged ≥60 years who underwent surgery for anterior fixation of odontoid fracture admitted from 2007 to 2016. Univariate analysis and subsequent multivariate analysis were used to analyze risk factors for postoperative complications and 30-day postoperative mortality. Complications were defined as surgical-site infection, wound breakdown, pneumonia, venous thromboembolism, stroke, myocardial infarction, sepsis, renal progressive renal insufficiency/acute kidney injury, or cardiac arrest. Results: A total of 198 patients were identified. Mean age was 77.7 (±8.7) years and 60.6% were female. Overall mortality rate was 7.6%, and the complication rate was 9.1%. In multivariate analysis, dependent functional status (0.012; odds ratio [OR] 5.2; 95% confidence interval [CI] 1.42–18.72) and preoperative systemic inflammatory response syndrome (P = 0.011; OR 6.2; 95% CI 1.52–25.79) predicted mortality. Emergency case status (P = 0.033; OR 3.4; 95% CI 1.10–10.70) predicted perioperative complications. Age was not significantly associated with either complications or mortality in multivariate analysis. Conclusions: Functional dependence and preoperative systemic inflammatory response syndrome predict mortality following odontoid screw placement. Although age often is considered a limiting factor in pursuing surgical intervention in patients with odontoid fracture, age did not independently increase odds of either complications or perioperative mortality in this analysis. Further studies are needed to explore these findings.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StatePublished - Jan 1 2019

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Databases
Mortality
Systemic Inflammatory Response Syndrome
Multivariate Analysis
Odds Ratio
Confidence Intervals
Current Procedural Terminology
Surgical Wound Infection
Fracture Fixation
Venous Thromboembolism
Quality Improvement
Heart Arrest
Acute Kidney Injury
Renal Insufficiency
Sepsis
Pneumonia
Emergencies
Stroke
Myocardial Infarction
Kidney

Keywords

  • Anterior screw fixation
  • Morbidity
  • Mortality
  • Odontoid fracture

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Perioperative Complications and Mortality Following Anterior Odontoid Screw Fixation in Elderly Patients : A National Database Analysis. / Longo, Michael; Gelfand, Yaroslav; De la Garza Ramos, Rafael; Echt, Murray; Kinon, Merritt D.; Yanamadala, V.; Yassari, Reza.

In: World Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Perioperative Complications and Mortality Following Anterior Odontoid Screw Fixation in Elderly Patients: A National Database Analysis",
abstract = "Objective: To identify predictors of short-term mortality and complications after anterior odontoid screw fixation. Methods: This was a retrospective analysis of a national database. The American College of Surgeons National Quality Improvement Database was queried using Current Procedural Terminology codes to identify patients aged ≥60 years who underwent surgery for anterior fixation of odontoid fracture admitted from 2007 to 2016. Univariate analysis and subsequent multivariate analysis were used to analyze risk factors for postoperative complications and 30-day postoperative mortality. Complications were defined as surgical-site infection, wound breakdown, pneumonia, venous thromboembolism, stroke, myocardial infarction, sepsis, renal progressive renal insufficiency/acute kidney injury, or cardiac arrest. Results: A total of 198 patients were identified. Mean age was 77.7 (±8.7) years and 60.6{\%} were female. Overall mortality rate was 7.6{\%}, and the complication rate was 9.1{\%}. In multivariate analysis, dependent functional status (0.012; odds ratio [OR] 5.2; 95{\%} confidence interval [CI] 1.42–18.72) and preoperative systemic inflammatory response syndrome (P = 0.011; OR 6.2; 95{\%} CI 1.52–25.79) predicted mortality. Emergency case status (P = 0.033; OR 3.4; 95{\%} CI 1.10–10.70) predicted perioperative complications. Age was not significantly associated with either complications or mortality in multivariate analysis. Conclusions: Functional dependence and preoperative systemic inflammatory response syndrome predict mortality following odontoid screw placement. Although age often is considered a limiting factor in pursuing surgical intervention in patients with odontoid fracture, age did not independently increase odds of either complications or perioperative mortality in this analysis. Further studies are needed to explore these findings.",
keywords = "Anterior screw fixation, Morbidity, Mortality, Odontoid fracture",
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T1 - Perioperative Complications and Mortality Following Anterior Odontoid Screw Fixation in Elderly Patients

T2 - A National Database Analysis

AU - Longo, Michael

AU - Gelfand, Yaroslav

AU - De la Garza Ramos, Rafael

AU - Echt, Murray

AU - Kinon, Merritt D.

AU - Yanamadala, V.

AU - Yassari, Reza

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N2 - Objective: To identify predictors of short-term mortality and complications after anterior odontoid screw fixation. Methods: This was a retrospective analysis of a national database. The American College of Surgeons National Quality Improvement Database was queried using Current Procedural Terminology codes to identify patients aged ≥60 years who underwent surgery for anterior fixation of odontoid fracture admitted from 2007 to 2016. Univariate analysis and subsequent multivariate analysis were used to analyze risk factors for postoperative complications and 30-day postoperative mortality. Complications were defined as surgical-site infection, wound breakdown, pneumonia, venous thromboembolism, stroke, myocardial infarction, sepsis, renal progressive renal insufficiency/acute kidney injury, or cardiac arrest. Results: A total of 198 patients were identified. Mean age was 77.7 (±8.7) years and 60.6% were female. Overall mortality rate was 7.6%, and the complication rate was 9.1%. In multivariate analysis, dependent functional status (0.012; odds ratio [OR] 5.2; 95% confidence interval [CI] 1.42–18.72) and preoperative systemic inflammatory response syndrome (P = 0.011; OR 6.2; 95% CI 1.52–25.79) predicted mortality. Emergency case status (P = 0.033; OR 3.4; 95% CI 1.10–10.70) predicted perioperative complications. Age was not significantly associated with either complications or mortality in multivariate analysis. Conclusions: Functional dependence and preoperative systemic inflammatory response syndrome predict mortality following odontoid screw placement. Although age often is considered a limiting factor in pursuing surgical intervention in patients with odontoid fracture, age did not independently increase odds of either complications or perioperative mortality in this analysis. Further studies are needed to explore these findings.

AB - Objective: To identify predictors of short-term mortality and complications after anterior odontoid screw fixation. Methods: This was a retrospective analysis of a national database. The American College of Surgeons National Quality Improvement Database was queried using Current Procedural Terminology codes to identify patients aged ≥60 years who underwent surgery for anterior fixation of odontoid fracture admitted from 2007 to 2016. Univariate analysis and subsequent multivariate analysis were used to analyze risk factors for postoperative complications and 30-day postoperative mortality. Complications were defined as surgical-site infection, wound breakdown, pneumonia, venous thromboembolism, stroke, myocardial infarction, sepsis, renal progressive renal insufficiency/acute kidney injury, or cardiac arrest. Results: A total of 198 patients were identified. Mean age was 77.7 (±8.7) years and 60.6% were female. Overall mortality rate was 7.6%, and the complication rate was 9.1%. In multivariate analysis, dependent functional status (0.012; odds ratio [OR] 5.2; 95% confidence interval [CI] 1.42–18.72) and preoperative systemic inflammatory response syndrome (P = 0.011; OR 6.2; 95% CI 1.52–25.79) predicted mortality. Emergency case status (P = 0.033; OR 3.4; 95% CI 1.10–10.70) predicted perioperative complications. Age was not significantly associated with either complications or mortality in multivariate analysis. Conclusions: Functional dependence and preoperative systemic inflammatory response syndrome predict mortality following odontoid screw placement. Although age often is considered a limiting factor in pursuing surgical intervention in patients with odontoid fracture, age did not independently increase odds of either complications or perioperative mortality in this analysis. Further studies are needed to explore these findings.

KW - Anterior screw fixation

KW - Morbidity

KW - Mortality

KW - Odontoid fracture

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