Treffer: Evaluating the Impact of Frailty on Mortality in Patients With Nonoperative and Operative Type II Odontoid Fracture: An American College of Surgeons Trauma Quality Improvement Program Survival Analysis of 22 440 Patients.
Title:
Evaluating the Impact of Frailty on Mortality in Patients With Nonoperative and Operative Type II Odontoid Fracture: An American College of Surgeons Trauma Quality Improvement Program Survival Analysis of 22 440 Patients.
Authors:
Courville EN; Department of Neurosurgery, Virginia Tech Carilion School of Medicine, Roanoke , Virginia , USA.; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Flint , Michigan , USA., Owodunni OP; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Flint , Michigan , USA.; Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque , New Mexico , USA., Schmidt MH; Department of Neurosurgery, MyMichigan Saginaw, Saginaw , Michigan , USA., Crandall CS; Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque , New Mexico , USA., Norii T; Department of Emergency Medicine, University of New Mexico Hospital, Albuquerque , New Mexico , USA., Bowers CA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Flint , Michigan , USA.; Department of Neurosurgery, Hurley Medical Center, Flint , Michigan , USA.
Source:
Neurosurgery [Neurosurgery] 2026 Jan 01; Vol. 98 (1), pp. 73-85. Date of Electronic Publication: 2025 Jul 17.
Publication Type:
Journal Article
Language:
English
Journal Info:
Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE
Imprint Name(s):
Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.
Original Publication: Baltimore, Williams & Wilkins.
Original Publication: Baltimore, Williams & Wilkins.
MeSH Terms:
Spinal Fractures*/mortality , Spinal Fractures*/therapy , Spinal Fractures*/surgery , Frailty*/mortality , Frailty*/complications , Odontoid Process*/injuries , Odontoid Process*/surgery, Humans ; Male ; Female ; Aged ; Retrospective Studies ; Middle Aged ; Quality Improvement ; Aged, 80 and over ; Survival Analysis ; United States/epidemiology ; Adult ; Length of Stay ; Propensity Score
References:
U.S. Census Bureau. Age and Sex Composition in the United States: 2020. Census.gov. https://www.census.gov/data/tables/2020/demo/age-and-sex/2020-age-sex-composition.html.
U.S. Census Bureau. An Aging Nation: The Older Population in the United States. Census.gov. https://www.census.gov/library/publications/2014/demo/p25-1140.html.
Neifert SN, Martini ML, Yuk F, et al. Predicting trends in cervical spinal surgery in the United States from 2020 to 2040. World Neurosurg. 2020;141:e175-e181.
Lofrese G, Musio A, De Iure F, et al. Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal? Eur Spine J. 2019;28(5):1064-1071.
Bronson WH, Protopsaltis T. Management of type II odontoid fractures in adults. Bull Hosp Jt Dis (2013). 2019;77(1):4-10.
Joaquim AF, Patel AA. Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion? Neurosurg Focus. 2015;38(4):e11.
Schroeder GD, Kepler CK, Kurd MF, et al. A systematic review of the treatment of geriatric type II odontoid fractures. Neurosurgery. 2015;77(Suppl 4):S6-S14.
Anderson LD, D’alonzo RT. Fractures of the odontoid process of the axis. J Bone Jt Surg Am Volume. 1974;56(8):1663-1674.
Carlstrom LP, Helal A, Perry A, Lakomkin N, Graffeo CS, Clarke MJ. Too frail is to fail: frailty portends poor outcomes in the elderly with type II odontoid fractures independent of management strategy. J Clin Neurosci. 2021;93:48-53.
Fagin AM, Cipolle MD, Barraco RD, et al. Odontoid fractures in the elderly: should we operate? J Trauma. 2010;68(3):583-586.
Graffeo CS, Perry A, Puffer RC, et al. Deadly falls: operative versus nonoperative management of Type II odontoid process fracture in octogenarians. J Neurosurg Spine. 2017;26(1):4-9.
Schoenfeld AJ, Bono CM, Reichmann WM, et al. Type II odontoid fractures of the cervical spine: do treatment type and medical comorbidities affect mortality in elderly patients? Spine. 2011;36(11):879-885.
Candura D, Perna A, Velluto C, et al. Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for? Eur Rev Med Pharmacol Sci. 2022;26(1 Suppl):33-42.
Pape HC, Kates SL, Hierholzer C, Bischoff-Ferrari HA, eds. Senior Trauma Patients: An Integrated Approach. 1st ed. Springer; 2022:303–316.
Chutkan NB, King AG, Harris MB. Odontoid fractures: evaluation and management. J Am Acad Orthop Surg. 1997;5(4):199-204.
Nourbakhsh A, Hanson ZC. Odontoid fractures: a standard review of current concepts and treatment recommendations. J Am Acad Orthop Surg. 2022;30(6):e561-e572.
Iyer S, Hurlbert RJ, Albert TJ. Management of odontoid fractures in the elderly: a review of the literature and an evidence-based treatment algorithm. Neurosurgery. 2018;82(4):419-430.
Lukins T, Nguyen L, Hansen MA, Ferch RD. Identifying factors influencing mortality in patients aged over 65 following an acute type II odontoid process fracture. A retrospective cohort study. Eur Spine J. 2021;30(6):1551-1555.
Hamrick FA, Sherrod BA, Cole K, et al. Using frailty measures to predict functional outcomes and mortality after type II odontoid fracture in elderly patients: a retrospective cohort study. Glob Spine J. 2024;14(5):1552-1562.
De Bonis P, Iaccarino C, Musio A, et al. Functional outcome of elderly patients treated for odontoid fracture: a multicenter study. Spine. 2019;44(13):951-958.
Chapman J, Smith JS, Kopjar B, et al. The AOSpine North America geriatric odontoid fracture mortality study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine. 2013;38(13):1098-1104.
Eslami MH, Saadeddin Z, Rybin DV, Doros G, Siracuse JJ, Farber A. Association of frailty index with perioperative mortality and in-hospital morbidity after elective lower extremity bypass. J Vasc Surg. 2019;69(3):863-874.e1.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
Ali R, Schwalb JM, Nerenz DR, Antoine HJ, Rubinfeld I. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine. 2016;25(4):537-541.
Hall A, Boulton E, Kunonga P, et al. Identifying older adults with frailty approaching end-of-life: a systematic review. Palliat Med. 2021;35(10):1832-1843.
Beaubien-Souligny W, Yang A, Lebovic G, Wald R, Bagshaw SM. Frailty status among older critically ill patients with severe acute kidney injury. Crit Care. 2021;25(1):84.
Ferrucci L, Cavazzini C, Corsi A, et al. Biomarkers of frailty in older persons. J Endocrinol Invest. 2002;25(10 Suppl):10-15.
Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901-908.
Sarode DP, Demetriades AK. Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review. Spine J. 2018;18(10):1921-1933.
Tracy BM, Adams MA, Schenker ML, Gelbard RB. The 5 and 11 factor modified frailty indices are equally effective at outcome prediction using TQIP. J Surg Res. 2020;255:456-462.
Shafi S, Nathens AB, Cryer HG, et al. The trauma quality improvement program of the American College of Surgeons Committee on trauma. J Am Coll Surg. 2009;209(4):521-530e1.
Tang OY, Shao B, Kimata AR, Sastry RA, Wu J, Asaad WF. The impact of frailty on traumatic brain injury outcomes: an analysis of 691 821 nationwide cases. Neurosurgery. 2022;91(5):808-820.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349.
Tracy BM, Wilson JM, Smith RN, Schenker ML, Gelbard RB. The 5-item modified Frailty Index predicts adverse outcomes in trauma. J Surg Res. 2020;253:167-172.
Dindo D. The Clavien–Dindo classification of surgical complications. Treatment of Postoperative Complications after Digestive Surgery; 2014:13-17.
Craney TA, Surles JG. Model-dependent variance inflation factor cutoff values. Qual Eng. 2002;14(3):391-403.
Dudley N, Wickham R, Coombs N. An introduction to survival statistics: Kaplan-Meier analysis. J Adv Pract Oncol. 2016;7(1):91-100.
Nathens AB, Cryer HG, Fildes J. The American College of Surgeons trauma quality improvement program. Surg Clin North Am. 2012;92(2):441-454; x-xi.
Hamilton P, Lawrence P, Eisenring CV. Treatment of type II odontoid fracture in the elderly. J Surg Case Rep. 2020;2020(8):rjaa235.
Pakzad H, Roffey DM, Knight H, Dagenais S, Yelle JD, Wai EK. Delay in operative stabilization of spine fractures in multitrauma patients without neurologic injuries: effects on outcomes. Can J Surg. 2011;54(4):270-276.
Robinson Y, Robinson AL, Olerud C. Systematic review on surgical and nonsurgical treatment of type II odontoid fractures in the elderly. BioMed Res Int. 2014;2014:231948.
Hersh AM, Pennington Z, Hung B, et al. Comparison of frailty metrics and the Charlson Comorbidity Index for predicting adverse outcomes in patients undergoing surgery for spine metastases. J Neurosurg Spine. 2021;36(5):849-857.
Lee ACH, Lee SM, Ferguson MK. Frailty is associated with adverse postoperative outcomes after lung cancer resection. JTO Clin Res Rep. 2022;3(11):100414.
Lascano D, Pak JS, Kates M, et al. Validation of a frailty index in patients undergoing curative surgery for urologic malignancy and comparison with other risk stratification tools. Urol Oncol. 2015;33(10):426.e1-426.e12.
Clements NA, Gaskins JT, Martin RCG. Predictive ability of comorbidity indices for surgical morbidity and mortality: a systematic review and meta-analysis. J Gastrointest Surg. 2023;27(9):1971-1987.
Hampton JP, Owodunni OP, Bettick D, et al. Compliance to an enhanced recovery pathway among patients with a high frailty index after major gastrointestinal surgery results in improved 30-day outcomes. Surgery. 2019;166(1):75-81.
Owodunni OP, Hampton J, Bettick D, et al. High compliance to an enhanced recovery pathway for patients ≥65 years undergoing major small and large intestinal surgery is associated with improved postoperative outcomes. Ann Surg. 2019;270(6):1117-1123.
Courville EN, Owodunni OP, Courville JT, et al. Frailty is associated with decreased survival in adult patients with nonoperative and operative traumatic subdural hemorrhage: a retrospective cohort study of 381,754 patients. Ann Surg Open. 2023;4(4):e348.
Woods BI, Hohl JB, Braly B, Donaldson W, Kang J, Lee JY. Mortality in elderly patients following operative and nonoperative management of odontoid fractures. J Spinal Disord Tech. 2014;27(6):321-326.
Bednar DA, Parikh J, Hummel J. Management of type II odontoid process fractures in geriatric patients; a prospective study of sequential cohorts with attention to survivorship. J Spinal Disord. 1995;8(2):166-169.
Shilpakar S, McLaughlin MR, Haid RW, Rodts GE, Subach BR. Management of acute odontoid fractures: operative techniques and complication avoidance. Neurosurg Focus. 2000;8(6):e3.
Wilson JRF, Badhiwala JH, Moghaddamjou A, Yee A, Wilson JR, Fehlings MG. Frailty is a better predictor than age of mortality and perioperative complications after surgery for degenerative cervical myelopathy: an analysis of 41,369 patients from the NSQIP database 2010-2018. J Clin Med. 2020;9(11):3491.
Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hébert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people. Lancet (London, England). 1999;353(9148):205-206.
Uzoukwu C, Owodunni OP, Peter-Okaka U, et al. Impact of frailty on all-cause mortality in older neurosurgical patients with prolonged hospitalization: a retrospective observational study. Aging Adv. 2024;1(2):69-77.
Sirisegaram L, Owodunni OP, Ehrlich A, Qin CX, Bettick D, Gearhart SL. Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older. BMC Geriatr. 2023;23(1):15.
Schmidt E, Balardy L, Geeraerts T, Costa N, Bowers CA, Hamilton M. Editorial. Geriatric neurosurgery: the unfolding of a new subspecialty. Neurosurg Focus. 2020;49(4):e2.
Ehrlich AL, Owodunni OP, Mostales JC, et al. Early outcomes following implementation of a multispecialty geriatric surgery pathway. Ann Surg. 2023;277(6):e1254-e1261.
Ehrlich AL, Owodunni OP, Mostales JC, et al. Implementation of a multi-specialty geriatric surgery pathway reduces inpatient cost for frail patients. Ann Surg. 2023;278(4):e726-e732.
U.S. Census Bureau. An Aging Nation: The Older Population in the United States. Census.gov. https://www.census.gov/library/publications/2014/demo/p25-1140.html.
Neifert SN, Martini ML, Yuk F, et al. Predicting trends in cervical spinal surgery in the United States from 2020 to 2040. World Neurosurg. 2020;141:e175-e181.
Lofrese G, Musio A, De Iure F, et al. Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal? Eur Spine J. 2019;28(5):1064-1071.
Bronson WH, Protopsaltis T. Management of type II odontoid fractures in adults. Bull Hosp Jt Dis (2013). 2019;77(1):4-10.
Joaquim AF, Patel AA. Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion? Neurosurg Focus. 2015;38(4):e11.
Schroeder GD, Kepler CK, Kurd MF, et al. A systematic review of the treatment of geriatric type II odontoid fractures. Neurosurgery. 2015;77(Suppl 4):S6-S14.
Anderson LD, D’alonzo RT. Fractures of the odontoid process of the axis. J Bone Jt Surg Am Volume. 1974;56(8):1663-1674.
Carlstrom LP, Helal A, Perry A, Lakomkin N, Graffeo CS, Clarke MJ. Too frail is to fail: frailty portends poor outcomes in the elderly with type II odontoid fractures independent of management strategy. J Clin Neurosci. 2021;93:48-53.
Fagin AM, Cipolle MD, Barraco RD, et al. Odontoid fractures in the elderly: should we operate? J Trauma. 2010;68(3):583-586.
Graffeo CS, Perry A, Puffer RC, et al. Deadly falls: operative versus nonoperative management of Type II odontoid process fracture in octogenarians. J Neurosurg Spine. 2017;26(1):4-9.
Schoenfeld AJ, Bono CM, Reichmann WM, et al. Type II odontoid fractures of the cervical spine: do treatment type and medical comorbidities affect mortality in elderly patients? Spine. 2011;36(11):879-885.
Candura D, Perna A, Velluto C, et al. Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for? Eur Rev Med Pharmacol Sci. 2022;26(1 Suppl):33-42.
Pape HC, Kates SL, Hierholzer C, Bischoff-Ferrari HA, eds. Senior Trauma Patients: An Integrated Approach. 1st ed. Springer; 2022:303–316.
Chutkan NB, King AG, Harris MB. Odontoid fractures: evaluation and management. J Am Acad Orthop Surg. 1997;5(4):199-204.
Nourbakhsh A, Hanson ZC. Odontoid fractures: a standard review of current concepts and treatment recommendations. J Am Acad Orthop Surg. 2022;30(6):e561-e572.
Iyer S, Hurlbert RJ, Albert TJ. Management of odontoid fractures in the elderly: a review of the literature and an evidence-based treatment algorithm. Neurosurgery. 2018;82(4):419-430.
Lukins T, Nguyen L, Hansen MA, Ferch RD. Identifying factors influencing mortality in patients aged over 65 following an acute type II odontoid process fracture. A retrospective cohort study. Eur Spine J. 2021;30(6):1551-1555.
Hamrick FA, Sherrod BA, Cole K, et al. Using frailty measures to predict functional outcomes and mortality after type II odontoid fracture in elderly patients: a retrospective cohort study. Glob Spine J. 2024;14(5):1552-1562.
De Bonis P, Iaccarino C, Musio A, et al. Functional outcome of elderly patients treated for odontoid fracture: a multicenter study. Spine. 2019;44(13):951-958.
Chapman J, Smith JS, Kopjar B, et al. The AOSpine North America geriatric odontoid fracture mortality study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine. 2013;38(13):1098-1104.
Eslami MH, Saadeddin Z, Rybin DV, Doros G, Siracuse JJ, Farber A. Association of frailty index with perioperative mortality and in-hospital morbidity after elective lower extremity bypass. J Vasc Surg. 2019;69(3):863-874.e1.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-M156.
Ali R, Schwalb JM, Nerenz DR, Antoine HJ, Rubinfeld I. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J Neurosurg Spine. 2016;25(4):537-541.
Hall A, Boulton E, Kunonga P, et al. Identifying older adults with frailty approaching end-of-life: a systematic review. Palliat Med. 2021;35(10):1832-1843.
Beaubien-Souligny W, Yang A, Lebovic G, Wald R, Bagshaw SM. Frailty status among older critically ill patients with severe acute kidney injury. Crit Care. 2021;25(1):84.
Ferrucci L, Cavazzini C, Corsi A, et al. Biomarkers of frailty in older persons. J Endocrinol Invest. 2002;25(10 Suppl):10-15.
Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210(6):901-908.
Sarode DP, Demetriades AK. Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review. Spine J. 2018;18(10):1921-1933.
Tracy BM, Adams MA, Schenker ML, Gelbard RB. The 5 and 11 factor modified frailty indices are equally effective at outcome prediction using TQIP. J Surg Res. 2020;255:456-462.
Shafi S, Nathens AB, Cryer HG, et al. The trauma quality improvement program of the American College of Surgeons Committee on trauma. J Am Coll Surg. 2009;209(4):521-530e1.
Tang OY, Shao B, Kimata AR, Sastry RA, Wu J, Asaad WF. The impact of frailty on traumatic brain injury outcomes: an analysis of 691 821 nationwide cases. Neurosurgery. 2022;91(5):808-820.
von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-349.
Tracy BM, Wilson JM, Smith RN, Schenker ML, Gelbard RB. The 5-item modified Frailty Index predicts adverse outcomes in trauma. J Surg Res. 2020;253:167-172.
Dindo D. The Clavien–Dindo classification of surgical complications. Treatment of Postoperative Complications after Digestive Surgery; 2014:13-17.
Craney TA, Surles JG. Model-dependent variance inflation factor cutoff values. Qual Eng. 2002;14(3):391-403.
Dudley N, Wickham R, Coombs N. An introduction to survival statistics: Kaplan-Meier analysis. J Adv Pract Oncol. 2016;7(1):91-100.
Nathens AB, Cryer HG, Fildes J. The American College of Surgeons trauma quality improvement program. Surg Clin North Am. 2012;92(2):441-454; x-xi.
Hamilton P, Lawrence P, Eisenring CV. Treatment of type II odontoid fracture in the elderly. J Surg Case Rep. 2020;2020(8):rjaa235.
Pakzad H, Roffey DM, Knight H, Dagenais S, Yelle JD, Wai EK. Delay in operative stabilization of spine fractures in multitrauma patients without neurologic injuries: effects on outcomes. Can J Surg. 2011;54(4):270-276.
Robinson Y, Robinson AL, Olerud C. Systematic review on surgical and nonsurgical treatment of type II odontoid fractures in the elderly. BioMed Res Int. 2014;2014:231948.
Hersh AM, Pennington Z, Hung B, et al. Comparison of frailty metrics and the Charlson Comorbidity Index for predicting adverse outcomes in patients undergoing surgery for spine metastases. J Neurosurg Spine. 2021;36(5):849-857.
Lee ACH, Lee SM, Ferguson MK. Frailty is associated with adverse postoperative outcomes after lung cancer resection. JTO Clin Res Rep. 2022;3(11):100414.
Lascano D, Pak JS, Kates M, et al. Validation of a frailty index in patients undergoing curative surgery for urologic malignancy and comparison with other risk stratification tools. Urol Oncol. 2015;33(10):426.e1-426.e12.
Clements NA, Gaskins JT, Martin RCG. Predictive ability of comorbidity indices for surgical morbidity and mortality: a systematic review and meta-analysis. J Gastrointest Surg. 2023;27(9):1971-1987.
Hampton JP, Owodunni OP, Bettick D, et al. Compliance to an enhanced recovery pathway among patients with a high frailty index after major gastrointestinal surgery results in improved 30-day outcomes. Surgery. 2019;166(1):75-81.
Owodunni OP, Hampton J, Bettick D, et al. High compliance to an enhanced recovery pathway for patients ≥65 years undergoing major small and large intestinal surgery is associated with improved postoperative outcomes. Ann Surg. 2019;270(6):1117-1123.
Courville EN, Owodunni OP, Courville JT, et al. Frailty is associated with decreased survival in adult patients with nonoperative and operative traumatic subdural hemorrhage: a retrospective cohort study of 381,754 patients. Ann Surg Open. 2023;4(4):e348.
Woods BI, Hohl JB, Braly B, Donaldson W, Kang J, Lee JY. Mortality in elderly patients following operative and nonoperative management of odontoid fractures. J Spinal Disord Tech. 2014;27(6):321-326.
Bednar DA, Parikh J, Hummel J. Management of type II odontoid process fractures in geriatric patients; a prospective study of sequential cohorts with attention to survivorship. J Spinal Disord. 1995;8(2):166-169.
Shilpakar S, McLaughlin MR, Haid RW, Rodts GE, Subach BR. Management of acute odontoid fractures: operative techniques and complication avoidance. Neurosurg Focus. 2000;8(6):e3.
Wilson JRF, Badhiwala JH, Moghaddamjou A, Yee A, Wilson JR, Fehlings MG. Frailty is a better predictor than age of mortality and perioperative complications after surgery for degenerative cervical myelopathy: an analysis of 41,369 patients from the NSQIP database 2010-2018. J Clin Med. 2020;9(11):3491.
Rockwood K, Stadnyk K, MacKnight C, McDowell I, Hébert R, Hogan DB. A brief clinical instrument to classify frailty in elderly people. Lancet (London, England). 1999;353(9148):205-206.
Uzoukwu C, Owodunni OP, Peter-Okaka U, et al. Impact of frailty on all-cause mortality in older neurosurgical patients with prolonged hospitalization: a retrospective observational study. Aging Adv. 2024;1(2):69-77.
Sirisegaram L, Owodunni OP, Ehrlich A, Qin CX, Bettick D, Gearhart SL. Validation of the self-reported domains of the Edmonton Frail Scale in patients 65 years of age and older. BMC Geriatr. 2023;23(1):15.
Schmidt E, Balardy L, Geeraerts T, Costa N, Bowers CA, Hamilton M. Editorial. Geriatric neurosurgery: the unfolding of a new subspecialty. Neurosurg Focus. 2020;49(4):e2.
Ehrlich AL, Owodunni OP, Mostales JC, et al. Early outcomes following implementation of a multispecialty geriatric surgery pathway. Ann Surg. 2023;277(6):e1254-e1261.
Ehrlich AL, Owodunni OP, Mostales JC, et al. Implementation of a multi-specialty geriatric surgery pathway reduces inpatient cost for frail patients. Ann Surg. 2023;278(4):e726-e732.
Contributed Indexing:
Keywords: Frailty; Modified frailty index-5; Risk assessment; Survival; Type II odontoid fracture
Entry Date(s):
Date Created: 20250717 Date Completed: 20251215 Latest Revision: 20251215
Update Code:
20251215
DOI:
10.1227/neu.0000000000003622
PMID:
40673686
Database:
MEDLINE
Weitere Informationen
Background and Objectives: Type II odontoid fractures (T2OF) are the most prevalent cervical spine injuries among the elderly. Nonetheless, there are insufficient data regarding the influence of frailty on outcomes for both nonoperative and operative treatment approaches. We sought to evaluate the influence of frailty on outcomes using 5-factor modified frailty index.
Methods: We performed a retrospective review of the American College of Surgeons Trauma Quality Improvement Program database from 2015 to 2020. We analyzed nonoperative and operative traumatic T2OF cases. Outcomes included major complications, hospital length of stay (LOS), nonhome discharge (NHD), mortality rates, and survival probabilities. We used unmatched and propensity score-matched risk-adjusted models to assess the association between frailty and all outcomes. Survival probabilities were examined using Kaplan-Meier plots, stratified by frailty strata.
Results: A total of 22 440 patients comprising 7138 (31.8%) robust, 7913 (35.2%) normal, 5158 (22.9%) frail, and 2231 (9.9%) very frail patients were included. Results from unmatched multivariable analyses revealed a dose-dependent relationship between frailty and all outcomes, in both cohorts ( P < .05). Propensity score-matched resulted in 3942 nonoperative and operative matched pairs. Preoperative characteristics were similar between cohorts, except for age: 75 years (IQR: 60-83) for nonoperative and 70 years (IQR: 56-78) for operative, and male sex: 1799 (55.8%) for nonoperative and 439 (61.1%) for operative cohorts. Significant mortality reductions (43%-77%; P < .05) were observed in the operative cohort compared with the nonoperative cohort across all frailty strata. As expected, the operative cohort had longer LOS and increased NHD risk ranging from 64% to 97%, P < .001. In Kaplan-Meier analyses, survival declined significantly across increasing frailty strata P < .001.
Conclusion: Increasing frailty was independently associated with major complications, LOS, NHD, and decreased survival. Operative patients exhibited improved survival compared with nonoperative patients across all frailty strata. These findings highlight the importance of frailty in T2OF management and care coordination.
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