Characteristics and outcomes of inpatients aged 85 and older with thoracolumbar vertebral fractures: impact on hospital stay and mortality.
Geriatric
Osteoporosis
Thoracolumbar vertebral fractures
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
22 Oct 2024
22 Oct 2024
Historique:
received:
07
07
2024
accepted:
03
10
2024
revised:
23
09
2024
medline:
22
10
2024
pubmed:
22
10
2024
entrez:
22
10
2024
Statut:
aheadofprint
Résumé
There is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on "short-term" hospital outcomes. All patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed. A total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as "Osteoporotic Fracture" (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%. VFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.
Sections du résumé
BACKGROUND
BACKGROUND
There is a gap in evidence about medical outcomes in oldest-old patients (aged 85 and older) with vertebral fractures (VFs). The aim of this study was to evaluate the impact of patient and fracture characteristics on "short-term" hospital outcomes.
METHODS
METHODS
All patients aged ≥ 85 presenting an acute or subsequent VF at our single level I spine center between 2019 and 2021 requiring hospital treatment were included. The data collection was conducted retrospectively. The primary parameters of interest were length of stay (LOS) and in-hospital mortality. Further outcome parameters were the occurrence of general (non-operative) complications and Intensive Care Unit (ICU) admission. For statistical analysis, linear and binary logistic regression modeling were performed.
RESULTS
RESULTS
A total of 153 patients with an average age of 88.5 (range 85 to 99) met the inclusion criteria. Our patients were mostly female (68.6%) and moderately comorbid according to a Charlson Comorbidity Index (CCI) of 2.9. 58.8% had diagnosed osteoporosis. Fracture morphologies represented as "Osteoporotic Fracture" (OF) classification types were of central importance for undergoing operative treatment (OP) (p < 0.001), necessity for intensive care (p = 0.023), LOS (p = 0.014), and mortality (p = 0.018). 38.6% had OP. We recorded a complication rate of 59.5%, which highly influenced (p < 0.001) both primary outcome parameters. Overall, patients stayed 14.6 days with a mortality of 11.1%.
CONCLUSION
CONCLUSIONS
VFs are a severe event in oldest-old patients with a crucial risk of poor medical outcomes during hospitalization. The fracture morphologies are of central importance. However, little is known about the hospital stay of oldest-old inpatients with VFs. Considering an aging population, further investigations would be recommended.
Identifiants
pubmed: 39436426
doi: 10.1007/s00586-024-08520-2
pii: 10.1007/s00586-024-08520-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Atella V, Piano Mortari A, Kopinska J, Belotti F, Lapi F, Cricelli C, Fontana L (2019) Trends in age-related disease burden and healthcare utilization. Aging Cell 18(1):e12861. https://doi.org/10.1111/acel.12861
doi: 10.1111/acel.12861
pubmed: 30488641
Ansah JP, Chiu CT (2023) Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. Front Public Health 10:1082183. https://doi.org/10.3389/fpubh.2022.1082183
doi: 10.3389/fpubh.2022.1082183
pubmed: 36711415
pmcid: 9881650
Chen J, Zhao M, Zhou R, Ou W, Yao P (2023) How heavy is the medical expense burden among the older adults and what are the contributing factors? A literature review and problem-based analysis. Front Public Health 11:1165381. https://doi.org/10.3389/fpubh.2023.1165381
doi: 10.3389/fpubh.2023.1165381
pubmed: 37397714
pmcid: 10313336
Li Z, Zhang Z, Ren Y, Wang Y, Fang J, Yue H, Ma S, Guan F (2021) Aging and age-related diseases: from mechanisms to therapeutic strategies. Biogerontology 22(2):165–187. https://doi.org/10.1007/s10522-021-09910-5
doi: 10.1007/s10522-021-09910-5
pubmed: 33502634
pmcid: 7838467
Jaul E, Barron J (2017) Age-Related diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population. Front Public Health 5:335. https://doi.org/10.3389/fpubh.2017.00335
doi: 10.3389/fpubh.2017.00335
pubmed: 29312916
pmcid: 5732407
Grote C, Reinhardt D, Zhang M, Wang J (2019) Regulatory mechanisms and clinical manifestations of musculoskeletal aging. J Orthop Res 37(7):1475–1488. https://doi.org/10.1002/jor.24292
doi: 10.1002/jor.24292
pubmed: 30919498
pmcid: 9202363
Barnsley J, Buckland G, Chan PE, Ong A, Ramos AS, Baxter M, Laskou F, Dennison EM, Cooper C, Patel HP (2021) Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res 33(4):759–773. https://doi.org/10.1007/s40520-021-01817-y
doi: 10.1007/s40520-021-01817-y
pubmed: 33742387
pmcid: 8084810
Sözen T, Özışık L, Başaran NÇ (2017) An overview and management of osteoporosis. Eur J Rheumatol 4(1):46–56. https://doi.org/10.5152/eurjrheum.2016.048
doi: 10.5152/eurjrheum.2016.048
pubmed: 28293453
Pouresmaeili F, Kamalidehghan B, Kamarehei M, Goh YM (2018) A comprehensive overview on osteoporosis and its risk factors. Ther Clin Risk Manag 14:2029–2049. https://doi.org/10.2147/TCRM.S138000
doi: 10.2147/TCRM.S138000
pubmed: 30464484
pmcid: 6225907
Armas LA, Recker RR (2012) Pathophysiology of osteoporosis: new mechanistic insights. Endocrinol Metab Clin North Am 41(3):475–486. https://doi.org/10.1016/j.ecl.2012.04.006
doi: 10.1016/j.ecl.2012.04.006
pubmed: 22877425
Kanis JA, on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield
Carey JJ, Delaney MF (2010) T-Scores and Z-Scores. Clin Rev Bone Min Metab 8:113–121. https://doi.org/10.1007/s12018-009-9064-4
doi: 10.1007/s12018-009-9064-4
Hadji P, Esterberg E, Obermüller D, Bartsch R (2024) Bone evaluation study-2: update on the epidemiology of osteoporosis in Germany. Arch Osteoporos 19(1):26. https://doi.org/10.1007/s11657-024-01380-9 . Erratum in: Arch Osteoporos. 2024;19(1):32. https://doi.org/10.1007/s11657-024-01388-1
Court-Brown CM, McQueen MM (2016) Global Forum: fractures in the Elderly. J Bone Joint Surg Am 98(9):e36. https://doi.org/10.2106/JBJS.15.00793
doi: 10.2106/JBJS.15.00793
pubmed: 27147693
Bergh C, Wennergren D, Möller M, Brisby H (2020) Fracture incidence in adults in relation to age and gender: a study of 27,169 fractures in the Swedish fracture Register in a well-defined catchment area. PLoS One 15(12):e0244291. https://doi.org/10.1371/journal.pone.0244291
doi: 10.1371/journal.pone.0244291
pubmed: 33347485
pmcid: 7751975
Boskey AL, Coleman R (2010) Aging and bone. J Dent Res 89(12):1333–1348. https://doi.org/10.1177/0022034510377791
doi: 10.1177/0022034510377791
pubmed: 20924069
pmcid: 2991386
Ensrud KE (2013) Epidemiology of fracture risk with advancing age. J Gerontol Biol Sci Med Sci 68(10):1236–1242. https://doi.org/10.1093/gerona/glt092
doi: 10.1093/gerona/glt092
Nuti R, Brandi ML, Checchia G, Di Munno O, Dominguez L, Falaschi P, Fiore CE, Iolascon G, Maggi S, Michieli R, Migliaccio S, Minisola S, Rossini M, Sessa G, Tarantino U, Toselli A, Isaia GC (2019) Guidelines for the management of osteoporosis and fragility fractures. Intern Emerg Med 14(1):85–102. https://doi.org/10.1007/s11739-018-1874-2
doi: 10.1007/s11739-018-1874-2
pubmed: 29948835
Rupp M, Walter N, Pfeifer C, Lang S, Kerschbaum M, Krutsch W, Baumann F, Alt V (2021) The incidence of Fractures among the Adult Population of Germany–an analysis from 2009 through 2019. Dtsch Arztebl Int 118(40):665–669. https://doi.org/10.3238/arztebl.m2021.0238
doi: 10.3238/arztebl.m2021.0238
pubmed: 34140088
pmcid: 8727861
Li HL, Shen Y, Tan LH, Fu SB, Dai RC, Yuan LQ, Sheng ZF, Xie ZJ, Wu XP, Liao EY, Tang XL, Wu XY (2021) Relationship between bone mineral density and fragility fracture risk: a case-control study in Changsha, China. BMC Musculoskelet Disord 22(1):728. https://doi.org/10.1186/s12891-021-04616-8
doi: 10.1186/s12891-021-04616-8
pubmed: 34429080
pmcid: 8386058
Bouxsein M, Genant H (2010) International Osteoporosis Foundation. The breaking spine. https://www.iofbonehealth.org
Diacinti D, Guglielmi G (2019) How to define an osteoporotic vertebral fracture? Quant Imaging Med Surg 9(9):1485–1494. https://doi.org/10.21037/qims.2019.09.10
doi: 10.21037/qims.2019.09.10
pubmed: 31667135
pmcid: 6785510
Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G (2017) Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 28(5):1531–1542. https://doi.org/10.1007/s00198-017-3909-3
doi: 10.1007/s00198-017-3909-3
pubmed: 28168409
Lang S, Walter N, Freigang V, Neumann C, Loibl M, Alt V, Rupp M (2023) Increased incidence of vertebral fractures in German adults from 2009 to 2019 and the analysis of secondary diagnoses, treatment, costs, and in-hospital mortality. Sci Rep 13(1):6984. https://doi.org/10.1038/s41598-023-31654-0
doi: 10.1038/s41598-023-31654-0
pubmed: 37117230
pmcid: 10147602
Weycker D, Li X, Barron R, Bornheimer R, Chandler D (2016) Hospitalizations for osteoporosis-related fractures: economic costs and clinical outcomes. Bone Rep 5:186–191. https://doi.org/10.1016/j.bonr.2016.07.005
doi: 10.1016/j.bonr.2016.07.005
pubmed: 28580386
pmcid: 5440958
Burge R, Puleo E, Gehlbach S, Worley D, Klar J (2002 Jul-Aug) Inpatient hospital and post-acute care for vertebral fractures in women. Value Health 5(4):301–311. https://doi.org/10.1046/j.1524-4733.2002.54126.x
Pankratz C, Risch A, Oxen J, Cintean R, Boehringer A, Gebhard F, Schuetze K (2023) Orthogeriatric care-outcome of different fragility fractures. Arch Orthop Trauma Surg 143(11):6641–6647. https://doi.org/10.1007/s00402-023-04993-w
doi: 10.1007/s00402-023-04993-w
pubmed: 37480380
pmcid: 10542290
Gosch M, Druml T, Nicholas JA, Hoffmann-Weltin Y, Roth T, Zegg M, Blauth M, Kammerlander C (2015) Fragility non-hip fracture patients are at risk. Arch Orthop Trauma Surg 135(1):69–77. https://doi.org/10.1007/s00402-014-2115-4
doi: 10.1007/s00402-014-2115-4
pubmed: 25412880
Spiegl UJA, Schenk P, Schnake KJ, Ullrich BW, Osterhoff G, Scheyerer MJ, Schmeiser G, Bäumlein M, Scherer MA, Müller M, Sprengel K, Liepold K, Schramm S, Baron HC, Siekmann H, Schwarz F, Franck A, Zimmermann V, Katscher S, Working Group Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma (2023) Treatment and outcome of osteoporotic thoracolumbar vertebral body fractures with deformation of both endplates with or without posterior wall involvement (OF 4): short-term results from the prospective EOFTT Multicenter Study. Global Spine J 13(1suppl):36S–43S. https://doi.org/10.1177/21925682221140831
doi: 10.1177/21925682221140831
pubmed: 37084347
pmcid: 10177306
Bouza C, López T, Palma M, Amate JM (2007) Hospitalised osteoporotic vertebral fractures in Spain: analysis of the national hospital discharge registry. Osteoporos Int 18(5):649–657. https://doi.org/10.1007/s00198-006-0292-x
doi: 10.1007/s00198-006-0292-x
pubmed: 17221295
Ong T, Sahota O, Gladman JRF (2020) The Nottingham Spinal Health (NoSH) study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 31(2):363–370. https://doi.org/10.1007/s00198-019-05198-x
doi: 10.1007/s00198-019-05198-x
pubmed: 31696271
Liu R, Chao A, Wang K, Wu J (2018) Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China. Arch Osteoporos 13(1):12. https://doi.org/10.1007/s11657-018-0429-5
doi: 10.1007/s11657-018-0429-5
pubmed: 29488018
pmcid: 5829109
Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN (2014) A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag 10:937–948. https://doi.org/10.2147/TCRM.S72456
doi: 10.2147/TCRM.S72456
pubmed: 25429224
pmcid: 4242696
Zohar A, Getzler I, Behrbalk E (2023) Higher mortality rate in patients with Vertebral Compression Fractures is due to Deteriorated Medical Status Prior to the fracture event. Geriatr Orthop Surg Rehabil 14:21514593231153106. https://doi.org/10.1177/21514593231153106
doi: 10.1177/21514593231153106
pubmed: 36760863
pmcid: 9903013
Ong T, Kantachuvesiri P, Sahota O, Gladman JRF (2018) Characteristics and outcomes of hospitalised patients with vertebral fragility fractures: a systematic review. Age Ageing 47(1):17–25. https://doi.org/10.1093/ageing/afx079
doi: 10.1093/ageing/afx079
pubmed: 29253103
Spiegl UJ, Hölbing PL, Jarvers JS, V D Höh N, Pieroh P, Osterhoff G, Heyde CE (2021) Midterm outcome after posterior stabilization of unstable midthoracic spine fractures in the elderly. BMC Musculoskelet Disord 22(1):188. https://doi.org/10.1186/s12891-021-04049-3
doi: 10.1186/s12891-021-04049-3
pubmed: 33588814
pmcid: 7885444
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8
doi: 10.1016/0021-9681(87)90171-8
pubmed: 3558716
World Health Organization (1996). Cancer pain relief: with a guide to opioid availability, 2nd edn. https://iris.who.int/handle/10665/37896
Tanna NK, Ong T (2022) Pharmacological options for pain control in patients with vertebral fragility fractures. Osteoporos Sarcopenia 8(3):93–97. https://doi.org/10.1016/j.afos.2022.09.003
doi: 10.1016/j.afos.2022.09.003
pubmed: 36268497
pmcid: 9577215
McCarthy J, Davis A (2016) Diagnosis and management of vertebral compression fractures. Am Fam Physician 94(1):44–50
pubmed: 27386723
Puth MT, Klaschik M, Schmid M, Weckbecker K, Münster E (2018) Prevalence and comorbidity of osteoporosis- a cross-sectional analysis on 10,660 adults aged 50 years and older in Germany. BMC Musculoskelet Disord 19(1):144. https://doi.org/10.1186/s12891-018-2060-4
doi: 10.1186/s12891-018-2060-4
pubmed: 29759066
pmcid: 5952640
Schnake KJ, Blattert TR, Hahn P, Franck A, Hartmann F, Ullrich B, Verheyden A, Mörk S, Zimmermann V, Gonschorek O, Müller M, Katscher S, Saman AE, Pajenda G, Morrison R, Schinkel C, Piltz S, Partenheimer A, Müller CW, Gercek E, Scherer M, Bouzraki N, Kandziora F (2018) Spine section of the German Society for Orthopaedics and Trauma. Classification of osteoporotic Thoracolumbar spine fractures: recommendations of the spine section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 8(2 Suppl):46S–49S. https://doi.org/10.1177/2192568217717972
doi: 10.1177/2192568217717972
pubmed: 30210960
pmcid: 6130101
Blattert TR, Schnake KJ, Gonschorek O, Gercek E, Hartmann F, Katscher S, Mörk S, Morrison R, Müller M, Partenheimer A, Piltz S, Scherer MA, Ullrich BW, Verheyden A, Zimmermann V (2018) Spine section of the German Society for Orthopaedics and Trauma. Nonsurgical and Surgical Management of osteoporotic vertebral body fractures: recommendations of the spine section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 8(2 Suppl):50S–55S. https://doi.org/10.1177/2192568217745823
doi: 10.1177/2192568217745823
pubmed: 30210962
pmcid: 6130106
Lee CS, Chien CV, Bidwell JT, Gelow JM, Denfeld QE, Masterson Creber R, Buck HG, Mudd JO (2014) Comorbidity profiles and inpatient outcomes during hospitalization for heart failure: an analysis of the U.S. Nationwide inpatient sample. BMC Cardiovasc Disord 14:73. https://doi.org/10.1186/1471-2261-14-73
doi: 10.1186/1471-2261-14-73
pubmed: 24898986
pmcid: 4057902
Wiedl A, Förch S, Fenwick A, Mayr E (2021) Stellenwert Der Operativen Behandlung Thorakolumbaler Wirbelkörperfrakturen für die Überlebenswahrscheinlichkeit alterstraumatologischer patienten [Importance of surgical treatment of thoracolumbar vertebral fractures for the survival probability of orthogeriatric patients]. Unfallchirurg 124(4):303–310 (German). https://doi.org/10.1007/s00113-020-00864-w
doi: 10.1007/s00113-020-00864-w
pubmed: 32930830
Zampini JM, White AP, McGuire KJ (2010) Comparison of 5766 vertebral compression fractures treated with or without kyphoplasty. Clin Orthop Relat Res 468(7):1773–1780. https://doi.org/10.1007/s11999-010-1279-7
doi: 10.1007/s11999-010-1279-7
pubmed: 20177836
pmcid: 2882011
Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251. https://doi.org/10.1016/0895-4356(94)90129-5
doi: 10.1016/0895-4356(94)90129-5
pubmed: 7722560
Gosch M, Kammerlander C, Neuerburg C (2019) Osteoporose – epidemiologie und Versorgungsqualität [Osteoporosis-epidemiology and quality of care]. Z Gerontol Geriatr 52(5):408–413 (German). https://doi.org/10.1007/s00391-019-01559-7
doi: 10.1007/s00391-019-01559-7
pubmed: 31139964
Spiegl UJ, Behr L, Osterhoff G, Rupprecht G, Scheyerer MJ, Katscher S (2022) OF spine classification of osteoporotic thoracolumbar vertebral body fractures by MRI and conventional radiographs only leads to high inter-observer agreement rates-an additional CT adds limited information for the of classification and the OF score. BMC Musculoskelet Disord 23(1):1086. https://doi.org/10.1186/s12891-022-06056-4
doi: 10.1186/s12891-022-06056-4
pubmed: 36510215
pmcid: 9743708
Rho YJ, Choe WJ, Chun YI (2012) Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty. Eur Spine J 21(5):905–911. https://doi.org/10.1007/s00586-011-2099-5
doi: 10.1007/s00586-011-2099-5
pubmed: 22160212
Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. AJNR Am J Neuroradiol 27(1):217–223 PMID: 16418388
pubmed: 16418388
pmcid: 7976057
Qiu Z, Wang P, Chao Y, Yu Y (2023) The risk of new vertebral fracture after percutaneous vertebral augmentation in patients suffering from single-level osteoporotic vertebral compression fractures: a meta-analysis and systematic review. Med (Baltim) 102(46):e35749. https://doi.org/10.1097/MD.0000000000035749
doi: 10.1097/MD.0000000000035749
Edidin AA, Ong KL, Lau E, Kurtz SM (2015) Morbidity and mortality after vertebral fractures: comparison of vertebral augmentation and Nonoperative Management in the Medicare Population. Spine (Phila Pa 1976) 40(15):1228–1241. https://doi.org/10.1097/BRS.0000000000000992
doi: 10.1097/BRS.0000000000000992
pubmed: 26020845