Inpatient Outcomes in Geriatric Complete Cervical Spinal Cord Injury: Associations Between Surgical Management and Reduced Mortality Despite Increased Morbidity.

Abstract

Study DesignRetrospective cohort study.ObjectivesWe aimed to identify factors associated with mortality and morbidity in geriatric patients with complete cervical spinal cord injury (cSCI) and compare outcomes to middle-aged patients using national trauma data.MethodsWe conducted a retrospective cohort study of 1147 patients aged ≥40 with complete cSCI from the 2019-2021 American College of Surgeons Trauma Quality Program. Patients were grouped as middle-aged (40-69 years, <i>n</i> = 798) or geriatric (≥70 years, <i>n</i> = 349). Those with severe head trauma or pre-admission death were excluded. Outcomes included in-hospital mortality, complications, intensive care unit (ICU) length of stay, and ventilator duration. Multivariate logistic and linear regression models assessed factors associated with each outcome.ResultsGeriatric patients had significantly higher mortality (60.7%) compared to middle-aged patients (23.2%, <i>P</i> < 0.001). Surgical management was associated with reduced mortality in both groups (OR 0.2, <i>P</i> < 0.001) but was less frequently performed in geriatric patients (59.9% vs 81.0%, <i>P</i> < 0.001). Complications were more common in middle-aged patients (47.6% vs 36.4%, <i>P</i> < 0.001), with surgery predicting increased complication risk. Geriatric patients had shorter ICU stays (11.2 vs 17.0 days, <i>P</i> < 0.001) and ventilator duration (11.6 vs 18.1 days, <i>P</i> < 0.001).ConclusionsGeriatric patients with complete cSCI had higher mortality and were less likely to undergo surgery, despite its association with improved survival. Lower morbidity in this group may reflect earlier mortality or less aggressive care. Individualized surgical decision-making is essential to ensure equitable treatment for older patients.