Does early surgical intervention for type II dens fractures improve survival in octogenarians? A propensity-matched analysis.

Abstract

Study design: Retrospective Cohort Study.

Objectives: To compare mortality and downstream morbidity after early operative versus nonoperative management of isolated Type II dens fractures in octogenarians.

Methods: TriNetX was queried to identify patients aged 80 years and older with a new diagnosis of Type II dens fracture. Patients with spinal cord injury, traumatic brain injury, or other major traumatic injuries were excluded. Patients were stratified by early operative intervention, defined as surgical fixation within 14 days, versus nonoperative management, defined as no surgical fixation after diagnosis. The primary outcome was mortality. Propensity score matching was performed 1:1 using demographic and clinical variables. Mortality was assessed at 9 months, 1 year, 2 years, and 3 years. Secondary outcomes included hospital readmission and long-term post-injury opioid use between 6 months and 3 years.

Results: After matching, 156 patients were included in each cohort. No significant differences in mortality were observed between cohorts at 9 months, 1 year, 2 years, or 3 years. Early operative intervention was associated with lower 90-day readmission (7.1% vs 17.9%; OR 0.35, 95% CI 0.17-0.73; p = 0.0036), lower 6-month readmission (9.0% vs 21.2%; OR 0.37, 95% CI 0.19-0.72; p = 0.0026), and lower long-term post-injury opioid use (16.0% vs 26.9%; OR 0.52, 95% CI 0.30-0.90; p = 0.0191).

Conclusions: In octogenarians with isolated Type II dens fractures, early surgery was not associated with improved long-term mortality, but was associated with lower readmission and reduced long-term post-injury opioid use.