Factors impacting mortality in geriatric patients with acute spine fractures: A 12-year study of 613 patients in Singapore

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.