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Early surgery for thoracolumbar extension-type fractures in geriatric patients with ankylosing disorders reduces patient complications and mortality

      Highlights

      • This study evaluates the effect of early surgery on elderly patients which present with unstable extension type fractures following minor trauma.
      • Delay of surgery (>72 hours) in geriatric patients presenting with an unstable extension type thoracolumbar fracture may cause an increase in medical complications and mortality at 6 months.

      ABSTRACT

      BACKGROUND CONTEXT

      The management of trauma patients with ankylosing spinal disorders has become an issue of increasing interest. Geriatric patients frequently sustain unstable extension type vertebral fractures with ankylosed spines. In this population, studies have shown that early surgery for other injuries such as hip fractures may reduce patient complications and mortality. These studies have changed patient care protocols in many medical centers worldwide.

      PURPOSE

      We aim to assess the relationship between the timing of surgery for unstable vertebral fractures in ankylosed spines in the geriatric population and patient outcomes.

      STUDY DESIGN/SETTING

      Retrospective clinical study conducted in a tertiary hospital.

      PATIENT SAMPLE

      Patients included were those diagnosed with isolated thoracolumbar extension type fractures and a spinal ankylosing disorder over 65 years old following minor trauma and with no additional injuries or neurological deficit.

      OUTCOME MEASURES

      Primary outcome measures included postoperative medical complications and mortality at 1 and 6 months. Secondary outcome measures included rehospitalization rates, length of stay, and surgical site infections.

      METHODS

      We searched our department's database for all that met our inclusion criteria who underwent surgery. The difference in patient outcomes that underwent early surgery defined as less than 72 hours from diagnosis as opposed to those that underwent later surgery was assessed.

      RESULTS

      A total of 82 patients underwent surgery following a diagnosis of an extension type thoracolumbar fracture at our institution between 2015 and 2021. Of these, 50 met inclusion criteria. Nineteen patients underwent surgery less than 72 hours from diagnosis and 31 more than 72 hours from diagnosis. No difference was found in age, functional status, and Elixhauser comorbidity scores between the groups. A statistically significant difference in perioperative patient complications between the early and the late groups (p=.005) was found. Mortality at six-months was significantly different between the groups as well (p=.035). There was no statistically significant difference between the groups when comparing surgical site infections, length of hospital stay, rehospitalization within a month, and perioperative mortality.

      CONCLUSIONS

      Time to surgery affects complication rates and six-month mortality in geriatric patients with spinal ankylosing disorders presenting with an isolated unstable hyperextension type thoracolumbar fracture. Early surgery of less than 72 hours from presentation in this patient population is recommended.

      Keywords

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      References

        • Westerveld LA
        • Verlaan JJ
        • Oner FC.
        Spinal fractures in patients with ankylosing spinal disorders: a systematic review of the literature on treatment, neurological status and complications.
        Eur Spine J. 2009; 18: 145-156https://doi.org/10.1007/s00586-008-0764-0
        • Rustagi T
        • Drazin D
        • Oner C
        • York J
        • Schroeder GD
        • Vaccaro AR
        • et al.
        Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes.
        J Orthop Trauma. 2017; 31: S57-S74https://doi.org/10.1097/BOT.0000000000000953
        • Caron T
        • Bransford R
        • Nguyen Q
        • Agel J
        • Chapman J
        • Bellabarba C.
        Spine fractures in patients with ankylosing spinal disorders.
        Spine (Phila Pa 1976). 2010; 35: E458-E464https://doi.org/10.1097/BRS.0b013e3181cc764f
        • Simunovic N
        • Devereaux PJ
        • Sprague S
        • Guyatt GH
        • Schemitsch E
        • DeBeer J
        • et al.
        Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis.
        CMAJ. 2010; 182: 1609-1616https://doi.org/10.1503/cmaj.092220
        • Bohm E
        • Loucks MsL
        • Wittmeier MsK
        • Lix LM
        • Oppenheimer L.
        Reduced time to surgery improves mortality and length of stay following hip fracture: results from an intervention study in a Canadian health authority.
        Can J Surg. 2015; 58: 257-263https://doi.org/10.1503/cjs.017714
        • Elkbuli A
        • Eily A
        • Polcz V
        • Boneva D
        • Spano PJ
        • McKenney M
        • et al.
        Isolated hip fracture in the elderly and time to surgery: is there an outcome difference?.
        Trauma Surgery and Acute Care Open. 2018; 3https://doi.org/10.1136/tsaco-2018-000212
      1. Bennett A, Li H, Patel A, Kang K, Gupta P, Choueka J, et al. Retrospective Analysis of Geriatric Patients Undergoing Hip Fracture Surgery: Delaying Surgery Is Associated With Increased Morbidity, Mortality, and Length of Stay n.d. https://doi.org/10.1177/2151459318795260.

        • Åhman R
        • Siverhall PF
        • Snygg J
        • Fredrikson M
        • Enlund G
        • Björnström K
        • et al.
        Determinants of mortality after hip fracture surgery in Sweden: a registry-based retrospective cohort study.
        Sci Rep. 2018; 8: 1-10https://doi.org/10.1038/s41598-018-33940-8
        • Weller I
        • Wai EK
        • Jaglal S
        • Kreder HJ.
        The effect of hospital type and surgical delay on mortality after surgery for hip fracture.
        J Bone Joint Surg - Series B. 2005; 87: 361-366https://doi.org/10.1302/0301-620X.87B3.15300
        • Lefaivre KA
        • Macadam SA
        • Davidson DJ
        • Gandhi R
        • Chan H
        • Broekhuyse HM.
        Length of stay, mortality, morbidity and delay to surgery in hip fractures.
        J Bone Joint Surg - Series B. 2009; 91: 922-927https://doi.org/10.1302/0301-620X.91B7.22446
        • Bellabarba C
        • Fisher C
        • Chapman JR
        • Dettori JR
        • Norvell DC.
        Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality?.
        Spine (Phila Pa 1976). 2010; 35https://doi.org/10.1097/BRS.0b013e3181d830c1
        • Vaccaro AR
        • Oner C
        • Kepler CK
        • Dvorak M
        • Schnake K
        • Bellabarba C
        • et al.
        AOSpine thoracolumbar spine injury classification system.
        Spine (Phila Pa 1976). 2013; 38https://doi.org/10.1097/BRS.0b013e3182a8a381
        • Resnick D
        • Niwayama G.
        Radiographic and pathologic features of spinal involvement in Diffuse Idiopathic Skeletal Hyperostosis (DISH).
        Radiology. 1976; 119https://doi.org/10.1148/119.3.559
        • Chipman JG
        • Deuser WE
        • Beilman GJ
        • Jurkovich GJ.
        Early surgery for thoracolumbar spine injuries decreases complications.
        J Trauma - Injury, Infect Critical Care. 2004; 56: 52-57https://doi.org/10.1097/01.TA.0000108630.34225.85
        • Frangen TM
        • Ruppert S
        • Muhr G
        • Schinkel C.
        The beneficial effects of early stabilization of thoracic spine fractures depend on trauma severity.
        J Trauma - Injury Infect Critical Care. 2010; 68: 1208-1212https://doi.org/10.1097/TA.0b013e3181a0e558
        • Schinkel C
        • Frangen TM
        • Kmetic A
        • Andress HJ
        • Muhr G.
        Timing of thoracic spine stabilization in trauma patients: impact on clinical course and outcome.
        J Trauma. 2006; 61 (discussion 160.): 156-160https://doi.org/10.1097/01.ta.0000222669.09582.ec
        • Bretherton CP
        • Parker MJ.
        Early surgery for patients with a fracture of the hip decreases 30-day mortality.
        Bone Joint J. 2015; 97-Bhttps://doi.org/10.1302/0301-620X.97B1.35041

      Further reading

        • Elixhauser A
        • Steiner C
        • Harris DR
        • Coffey RM.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27