Protect the neck: Devastating outcomes of cervical spine fractures in the elderly.

BACKGROUND:Cervical spine fractures are associated with high mortality in elderly patients. This study aims to identify patient-related and in-hospital factors contributing to this mortality. METHODS:A 3-year retrospective study of 235 patients aged 65+ presenting with cervical spine fractures was performed. Age cohorts were 65-74, 75-84, and 85+ years. Mortality was measured at 30, 90, 180 and 365-days post-discharge. RESULTS:Mortality was 11 ​%, 15 ​%, 19 ​%, and 22 ​% at 30-, 90-, 180- and 365-days respectively. Surgery and fracture pattern was not associated with mortality (p ​= ​0.37; p ​= ​0.28). Charlson Comorbidity Index (p ​< ​0.001; hazard ratio [HR] ​= ​1.3), functional dependency (p ​< ​0.001; HR ​= ​2.5) and delirium (p ​< ​0.001; HR ​= ​8.9) were associated with mortality between 0 and 365 days post-discharge. CONCLUSIONS:Mortality in cervical spine fractures is associated with CCI and delirium, but not associated with operative management or fracture pattern. This suggests the need for careful consideration in patient selection for cervical spine procedures and aggressive inpatient delirium management.