Tom Lübstorf1, Marcel A Kopp2,3, Christian Blex1, Jan M Schwab1,4, Ulrike Grittner5,6, Thomas Auhuber7,8, Axel Ekkernkamp9, Andreas Niedeggen10,11, Erik Prillip11, Magdalena Hoppe1,11, Johanna Ludwig11, Martin Kreutzträger11, Thomas Liebscher1,11. 1. Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany. 2. Clinical and Experimental Spinal Cord Injury Research (Neuroparaplegiology), Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany. marcel.kopp@charite.de. 3. Berlin Institute of Health, QUEST-Center for Transforming Biomedical Research, Berlin, Germany. marcel.kopp@charite.de. 4. Belford Center for Spinal Cord Injury, Departments of Neurology, Physical Medicine and Rehabilitation, and Neurosciences, The Neuroscience Institute, The Ohio State University, Wexner Medical Center, Columbus, OH, USA. 5. Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany. 6. Berlin Institute of Health, Berlin, Germany. 7. Medical Management, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany. 8. University of Applied Sciences of the German Statutory Accident Insurance (HGU), Bad Hersfeld, Germany. 9. Clinic for Trauma Surgery and Orthopaedics, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany. 10. Brandenburg Center for Spinal Cord Injuries, Kliniken Beelitz, Beelitz-Heilstätten, Germany. 11. Treatment Centre for Spinal Cord Injuries, BG Hospital Unfallkrankenhaus Berlin, Berlin, Germany.
Abstract
PURPOSE: To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI). METHODS: Ambispective cohort study (2011-2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (> 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression. RESULTS: The median age of the study population was 58.8 years (42.0-74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2-121.3) compared to 6.6 h (4.4-47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85-9.65), as mirrored by adjusted spline curves (< 20 h 20-25%, 20-60 h 10-20%, > 60 h < 10% probability of AIS conversion). In incomplete SCI, the probability of AIS conversion was lower in older patients [e.g., OR 0.09 (0.02-0.44) for'45-59y' vs.' ≤ 44y'], as confirmed by spline curves (< 40y 20-80%, ≥ 40y 5-20% probability). CONCLUSION: Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.
PURPOSE: To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI). METHODS: Ambispective cohort study (2011-2017) in n = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (> 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression. RESULTS: The median age of the study population was 58.8 years (42.0-74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2-121.3) compared to 6.6 h (4.4-47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85-9.65), as mirrored by adjusted spline curves (< 20 h 20-25%, 20-60 h 10-20%, > 60 h < 10% probability of AIS conversion). In incomplete SCI, the probability of AIS conversion was lower in older patients [e.g., OR 0.09 (0.02-0.44) for'45-59y' vs.' ≤ 44y'], as confirmed by spline curves (< 40y 20-80%, ≥ 40y 5-20% probability). CONCLUSION: Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.
Authors: F Biering-Sørensen; M J DeVivo; S Charlifue; Y Chen; P W New; V Noonan; M W M Post; L Vogel Journal: Spinal Cord Date: 2017-05-30 Impact factor: 2.772
Authors: Jetan H Badhiwala; Jefferson R Wilson; Christopher D Witiw; James S Harrop; Alexander R Vaccaro; Bizhan Aarabi; Robert G Grossman; Fred H Geisler; Michael G Fehlings Journal: Lancet Neurol Date: 2020-12-21 Impact factor: 44.182
Authors: Marc Maegele; Rolf Lefering; Oliver Sakowitz; Marcel A Kopp; Jan M Schwab; Wolf-Ingo Steudel; Andreas Unterberg; Reinhard Hoffmann; Eberhard Uhl; Ingo Marzi Journal: Dtsch Arztebl Int Date: 2019-03-08 Impact factor: 5.594
Authors: Jefferson R Wilson; Aileen M Davis; Abhaya V Kulkarni; Alex Kiss; Ralph F Frankowski; Robert G Grossman; Michael G Fehlings Journal: Spine J Date: 2013-11-07 Impact factor: 4.166