128 Prevalence of Older People Presenting Acutely to A Regional Spine Unit

Abstract

Background With ageing demographics, the number of older people is expectedto rise exponentially over the next decade. With increasingnumbers, the numbers of patients presenting to hospital will alsoincrease. These patients have significant underlying comorbiditiesand thus further surgical interventions are more challenging. Objective To investigate the incidence of all in-patient referrals to theNottingham Regional Spinal unit for patients aged 70 years and above over a 30-month period. Methods A retrospective 30-month review (Jan 2017-Aug 2019) of theclinical records of all in-patients' referrals to the regional spinalunit (catchment population 4.5 million) for patients aged 70 yearsand above was undertaken. Patient demographics, co-morbidities,cause of referral, treatment modality (conservative vs. surgical),length of hospital stay, discharge destination (home vs. rehab) and mortality rates were collected and analysed. Results A total of 677 (Male: 335, Female: 342) in-patients' referrals forpatients aged 70 years and above were received. The mean age atpresentation was 82.3 (+/-7.48) years. Trauma (low & high energy)was the most common cause of inpatient referrals (n = 448;66.2%). Low energy trauma (insufficiency) fractures contributedto more than half of the total referrals (n = 256). Spondylodiscitiswas the least common cause of referral (n = 34; 5%). Five-hundred forty-five patients were treated conservatively (80.5%). Averagelength of hospital stay was 16.7 days (range:1-282 days). Eighty-one of the discharged patients (13.5%) were transferred torehabilitation after discharge, and the over-all 30-day mortalityrate was 11.5% (n = 78). Conclusion Frail older people represent a significant workload to the regionalspine unit. Adapting an ortho-geriatric model of care as with hipfracture care may be the optimal model of service delivery toimprove outcomes for this patients group.