- Department of Neurosurgery, Ohio Health, Grant Medical Center, Columbus, Ohio, USA
- Department of Neurosurgery, Riverside Methodist Hospital, Columbus, Ohio, USA
Rudy D. Marciano
Department of Neurosurgery, Ohio Health, Grant Medical Center, Columbus, Ohio, USA
DOI:10.4103/sni.sni_231_17Copyright: © 2018 Surgical Neurology International This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
How to cite this article: Rudy D. Marciano, Brian Seaman, Saurabh Sharma, Teresa Wood, Chris Karas, Kailash Narayan. Incidence of dysphagia after odontoid screw fixation of type II odontoid fracture in the elderly. 16-Apr-2018;9:84
How to cite this URL: Rudy D. Marciano, Brian Seaman, Saurabh Sharma, Teresa Wood, Chris Karas, Kailash Narayan. Incidence of dysphagia after odontoid screw fixation of type II odontoid fracture in the elderly. 16-Apr-2018;9:84. Available from: http://surgicalneurologyint.com/surgicalint-articles/incidence-of-dysphagia-after-odontoid-screw-fixation-of-type-ii-odontoid-fracture-in-the-elderly/
Background:Although surgery may reduce mortality rates from type II odontoid fractures in the elderly population, post-operative dysphagia resulting from screw fixation remains a serious complication.
Methods:We retrospectively performed a chart review of patients over 65 years of age who underwent odontoid screw placement for type II odontoid fractures (2009-2014) and sustained post-operative dysphagia. The severity of dysphagia was determined based on the requirements for modified diets, PEG tubes, and prolonged length of stay (LOS), while costs were based upon discharge disposition (e.g. home vs. rehabilitation facilities) and total hospital costs.
Results:The incidence of postoperative dysphagia was 80%; 33% required feeding tubes, and 35% warranted PEG placement. The mean LOS for patients with dysphagia was 5 days longer and the total hospital costs averaged $50,000 higher.
Conclusions:Age over 65 is a significant predictor of post-operative dysphagia in patients undergoing type II odontoid screw fixation. Notably, with each additional year above 65, the likelihood of post-operative dysphagia increased by 12%. Furthermore, postoperative dysphagia statistically increased the LOS and total costs.
Keywords: Dens fracture, dysphagia, non-union, odontoid fracture, odontoid screw
Fractures of the axis are the most common cervical spine fracture in the elderly population.[
Here, for patients >65 years of age with type II odontoid fractures treated with screw fixation, the authors documented the incidence of postoperative dysphagia, its complications, and costs. Dysphagia was most typically attributed to; hematoma formation, retropharyngeal swelling, fracture displacement, and/or cervical immobilization that impaired swallowing.[
Post-operative dysphagia following anterior odontoid screw fixation frequently resolves, but occasionally requires feeding tubes and/or percutaneous endoscopic gastrostomy (PEG) resulting in more prolonged length of stay (LOS) and hospital costs. This complication of the anterior approach may prompt more surgeons to alternatively consider posterior cervical fixation for type II odontoid fractures in the elderly.[
This study evaluated 40 patients undergoing anterior odontoid screw fixation, and assesses the incidence of post-operative dysphagia along with increased LOS, and hospital costs.
Forty patients over the age of 65 underwent odontoid screw fixation for type 2 odontoid fractures (2009-2014). Shortcomings of the study design included; surgeons’ independent decision to utilize odontoid screw fixation (no fixed criteria), the failure to document dysphagia preoperatively and the retrospective design of the study (e.g. data obtained from patients’ medical records). Although multiple clinical variables were assessed (see
Frequency distributions and summary statistics were used to describe demographic and medical history data (see
80% of patients undergoing anterior type II odontoid fracture fixation exhibited post-operative dysphagia; 72% underwent a postoperative barium swallow. 44% of those with dysphagia required PEG tube insertion.
Older age correlated with increased dysphagia following anterior odontoid fixation [ Table 1 ]
Older age correlated with a higher risk of dysphagia; for 32 patients with dysphagia the average age was 86.2, for the 8 without dysphagia it was 79.6 years. For each added year of age over 65, the risk of post-op dysphagia increased 12% (odds ratio = 1.12, 95% confidence interval: 1.001, 1.258).
Dysphagia increased LOS [ Table 1 ]
Dysphagia clearly increased the average length of stay. The mean LOS for the dysphagia group was 11.9+/- 5.99 versus 7.0+/- 3.55 days for those without dysphagia (P = 0.035).
Dysphagia diagnoses increased discharges to skilled nursing facilities [ Table 1 ]
Regardless of dysphagia status, patients were discharged to either skilled nursing facilities (53%) or home (40%) with or without home health care services. The number of patients requiring tube feedings was too small to assess their impact on discharge disposition.
Dysphagia increased hospital costs [ Table 1 ]
Dysphagia significantly increased hospital costs. Inpatient hospital costs were almost $50,000 greater for those with post-operative dysphagia; they were $38,000 higher for those requiring PEG tube placement.
The elderly population (e.g. over the age of 65) experiencing type 2 odontoid fractures is increasing.[
This study reviewed the incidence of post-operative dysphagia following 40 anterior screw fixation procedures performed in patients over the age of 65 with type II odontoid fractures. Here we documented an 80% incidence of postoperative dysphagia; 67% required tube feeds during the admission, 32% still required tube feeds upon discharge, while 35% required PEG tube placement. Older age correlated with an increased incidence of dysphagia; the 32 patients with dysphagia averaged 86.2 years of age, while the 8 without dysphagia averaged just 79.6 years old. With each year above 65, the risk of post-operative dysphagia increased by 12%.
Dysphagia correlated with a longer LOS; 11.9 with vs. 7 days without dysphagia, while those requiring PEG had an average LOS of 13.4 days vs. 9 days without. Furthermore, hospital costs were significantly higher for those with post-operative dysphagia; the total cost of an inpatient stay was approximately $50,000 higher, regardless of need for PEG tube placement.
The incidence of post-operative dysphagia was 80% for 40 patients over the age of 65 undergoing anterior screw fixation for type II odontoid fractures. Postoperative dysphagia, requiring feeding tubes and/or PEG placement, significantly increased the LOS and average inpatient hospital costs by more than $50,000.
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Conflicts of interest
There are no conflicts of interest.
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