Mortality Rates in Elderly Patients With Traumatic Spinal Cord Injury

Introduction This study aimed to identify the six-month mortality rate in elderly patients with traumatic spinal cord injuries, examining both surgical and non-surgical management approaches. Our secondary objective aimed to identify risk factors contributing to mortality. Methods A retrospective observational analysis was conducted on patients aged 65 and older with spinal cord injuries admitted to Middlemore Spinal Cord Injury Unit between 2014 and early 2022. After exclusions, 130 data points were analysed. Data was collected from clinical records and analysed using descriptive statistics. Survival and mortality rates for surgical and non-surgical groups were calculated, while factors such as age, sex, ethnicity, BMI, injury mechanism, smoking status, and neurological severity (ASIA Impairment Scale) were evaluated. Chi-square and Fisher's exact tests were used for variable-outcome comparisons. Cox regression models adjusted for clinically relevant confounding variables. Results Participants’ ages ranged from 65 to 95; 77.7% were male. Surgical patients exhibited a 14.3% six-month mortality rate, compared to 28.2% in non-surgical patients. Statistical significance was limited by small cohort size, but increased mortality was associated with a high comorbidity index. Statistically significant mortality was noted with ASIA A/B versus C/D/E scores; being 28.89% and 6.94%, respectively. Patients over 85 reflected significant mortality in surgical cases, with two thirds of these patients deceased at 6 months. Unique to the New Zealand population; Māori represented the only ethnic group with mortality exceeding survival at 55%. Discussion and Conclusion This research highlights the challenges clinicians face managing elderly patients with traumatic spinal cord injuries. Increased mortality was associated with age, injury severity, and comorbidities. These findings also highlight discrepancies of outcomes within the New Zealand population and serve as a foundation for further research, aimed to guide clinical decision making and discussions with patients and families.