In-Hospital Mortality for the Elderly Suffering Acute Traumatic Spinal Cord Injury.

As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are increasingly faced with difficult discussions regarding aggressiveness of management, likelihood of recovery and survival. Our objective was to outline risk factors associated with in-hospital mortality in elderly surgical and non-surgical patients following tSCI and to determine those unlikely to have a favourable outcome. Data from elderly patients (≥65 years) within the Canadian Rick Hansen SCI Registry from 2004 to 2017 were analyzed using descriptive analysis. Survival and mortality groups within each of the surgical and non-surgical group were compared to explore factors associated with in-hospital mortality and their impact using logistic regression. Of 1340 elderly patients, 1018 had surgical data with 826 having had surgery. In the surgical group, the median time to death post-injury is 30 days with 75% dying within 50 days compared to 7 days and 20 days respectively in the non-surgical group. Significant predictors for in-hospital mortality following surgery are age, comorbidities, neurological injury severity (AIS), and ventilation status. The odds of dying 50 days post-surgery are 6 times higher for patients ≥77 vs 65-76, 5 times higher for those with AIS A vs AIS B/C/D, and 7 times higher for ventilator-dependent. An expected probability of dying within 50 days post-surgery was determined using these results. In-hospital mortality in the elderly after tSCI is high. The trend with age and time to death and the significant predictors of mortality identified in this study can be used to inform clinical decision-making and discussions with patients and their families.