Mortality and decision making in older patients with cervical fracture

Operative treatment for patients with cervical spine fractures is associated with a lower mortality rate at 3 months but not 1 year postsurgery in patients who were between 65 and 74 years at the time of fracture. Factors that may influence mortality include age, comorbidities, male sex, and neurological involvement.

Harris and associates reviewed data collected from 640 persons 65 years and older treated for cervical fractures. They focused on 3- and 12-month mortality rates and related risk factors.

The overall 3-month mortality rate, 19%, increased with age. The rate did not differ significantly with surgical versus conservative treatment, but age had a critical influence: surgery improved survival in younger patients but not in older ones. Comorbidity and neurological damage increased postfracture mortality. The results at 1 year paralleled those observed at 3 months, except that the mortality rate was 28% overall. For the younger patients, operative treatment decreased mortality at 3 months but not at 1 year.

The authors noted that the physician should not emphasize the chosen method of treatment to the patient or the family as the critical determinant of short- or long-term mortality because it is just 1 variable to be considered in the decision-making process.