Type II Odontoid Fractures May Up Elderly Mortality Risk

Surgical intervention may offer a protective benefit in patients aged 65 to 74 years

MONDAY, May 23 (HealthDay News) -- Type II odontoid fractures in the elderly are associated with a high mortality rate irrespective of the intervention, according to a study published in the May 15 issue of Spine.

Andrew J. Schoenfeld, M.D., from the Brigham and Women's Hospital in Boston, and colleagues investigated the influence of age, comorbidities, and treatment type on mortality in 156 patients, with an average age of 82 years, with acute Type II odontoid fractures sustained between 1991 and 2006. The National Death Index was used to assess mortality, and risks of mortality were calculated at three months, and one, two, and three years. Independent factors affecting mortality were evaluated according to age (65 to74 years, 75 to 84 years, 85 years or older), and treatment type (operative or nonoperative [72 percent], and halo or collar immobilization).

The investigators found that there was a mortality rate of 39 percent for the entire cohort at three years, post-injury. The three- and 12-month mortality was 11 and 21 percent, respectively, for the operative group, and 25 and 36 percent, respectively, for the nonoperative group. Patients aged 65 to 74 years experienced the protective effect of operative treatment with a hazard ratio of 0.4 for mortality after surgery. The hazard ratio for mortality after surgery was 0.8 for those aged 75 to 84 years, and 1.9 for patients 85 years or older.

"In a cohort of elderly patients, Type II odontoid fractures were associated with a high rate of mortality, regardless of intervention," the authors write.

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