Asian Spine J.  2019 Aug;13(4):563-568. 10.31616/asj.2018.0231.

Factors Impacting Mortality in Geriatric Patients with Acute Spine Fractures: A 12-Year Study of 613 Patients in Singapore

• Soon EL
• Leong AZ
• Chiew J
• Kaliya-Perumal AK
• Yu CS
• Oh JY

• KMID: 2455645
• DOI: http://doi.org/10.31616/asj.2018.0231

Abstract

STUDY DESIGN: Retrospective database analysis. PURPOSE: To identify risk factors that predict mortality following acute spine fractures in geriatric patients of Singapore. OVERVIEW OF LITERATURE: Acute geriatric spinal fractures contribute significantly to local healthcare costs and hospital admissions. However, geriatric mortality following acute spine fractures is scarcely assessed in the Asian population.
METHODS
Electronic records of 3,010 patients who presented to our hospital's emergency department and who were subsequently admitted during 2004-2015 with alleged history of traumatic spine fractures were retrospectively reviewed, and 613 patients (mean age, 85.7±4.5 years; range, 80-101 years; men, 108; women, 505) were shortlisted. Mortality rates were reviewed up to 1 year after admission and multivariate analyses were performed to identify independent risk factors correlating with mortality.
RESULTS
Women were more susceptible to spine fractures (82.4%), with falls (77.8%) being the most common mechanism of injury. Mortality rates were 6.0%, 8.2%, and 10.4% at 3, 6, and 12 months, respectively. The most common causes of death at all 3 time points were pneumonia and ischemic heart disease. Based on the multivariate analysis at 1-year follow-up, elderly women had a lower mortality rate compared to men (p<0.001); mortality rates increased by 6.3% (p=0.024) for every 1-year increase in the patient's age; and patients with an American Spinal Injury Association (ASIA) score of A-C had a much higher mortality rate compared to those with an ASIA score of D-E (p<0.001).
CONCLUSIONS
An older age at presentation, male sex, and an ASIA score of A-C were identified as independent factors predicting increased mortality among geriatric patients who sustained acute spine fractures. The study findings highlight at-risk groups for acute spine fractures, thereby providing an opportunity to develop strategies to increase the life expectancy of these patients.

Keyword

Accidental falls; Mortality; Spinal cord injuries; Spinal fractures; Spinal injuries

MeSH Terms

Accidental Falls
Aged
Asia
Asian Continental Ancestry Group
Cause of Death
Emergency Service, Hospital
Female
Follow-Up Studies
Health Care Costs
Humans
Life Expectancy
Male
Mortality*
Multivariate Analysis
Myocardial Ischemia
Pneumonia
Retrospective Studies
Risk Factors
Singapore*
Spinal Cord Injuries
Spinal Fractures
Spinal Injuries
Spine*