Preoperative frailty and 30-day mortality after surgery for type II odontoid fracture: a retrospective observational analysis of a large multicenter surgical registry

Abstract

Type 2 odontoid fractures (T2OF), defined by fracture through base of dens, account for ∼50% odontoid fractures and usually result in cervical instability[ [1] Tenny S Varacallo M. Odontoid Fractures. StatPearls. StatPearls Publishing, 2022http://www.ncbi.nlm.nih.gov/books/NBK441956/ Google Scholar ]. There is lack of consensus regarding which patients are appropriate for non-operative (external immobilization) versus operative (surgical fixation, multiple approaches) management[ [1] Tenny S Varacallo M. Odontoid Fractures. StatPearls. StatPearls Publishing, 2022http://www.ncbi.nlm.nih.gov/books/NBK441956/ Google Scholar ]. Many surgeons lean towards non-operative management in elderly patients[ [1] Tenny S Varacallo M. Odontoid Fractures. StatPearls. StatPearls Publishing, 2022http://www.ncbi.nlm.nih.gov/books/NBK441956/ Google Scholar ]. However, nonunion rates with brace therapy increase significantly with age and some elderly poorly tolerate external immobilization therapy[ [1] Tenny S Varacallo M. Odontoid Fractures. StatPearls. StatPearls Publishing, 2022http://www.ncbi.nlm.nih.gov/books/NBK441956/ Google Scholar ]. Frailty is a measure of physiological reserve and valuable risk stratification tool in the preoperative setting. The Risk Analysis Index (RAI) is a robust index based on accumulation of deficits model of frailty[ [2] Hall DE Arya S Schmid KK et al. Development and initial validation of the risk analysis index for measuring frailty in surgical populations. JAMA Surg. 2017; 152: 175-182 Crossref PubMed Scopus (173) Google Scholar , [3] Arya S Varley P Youk A et al. Recalibration and External Validation of the Risk Analysis Index: A Surgical Frailty Assessment Tool. Ann Surg. 2020; 272: 996-1005https://doi.org/10.1097/SLA.0000000000003276 Crossref PubMed Scopus (57) Google Scholar ]. However, the clinical utility of RAI across the spectrum of spine pathology is unclear[ [4] Pazniokas J Gandhi C Theriault B et al. The immense heterogeneity of frailty in neurosurgery: a systematic literature review. Neurosurg Rev. 2021; 44: 189-201https://doi.org/10.1007/s10143-020-01241-2 Crossref PubMed Scopus (32) Google Scholar ]. The aim of the present study was to analyze the association of preoperative frailty, as measured by RAI, with 30-day mortality after surgical treatment of T2OF using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 2015-2020.