{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:48:41Z","timestamp":1786124921831,"version":"build-2736575974"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>BACKGROUND:<\/jats:bold>\n                    Management of axis fractures in the elderly remains controversial. As the US population increasingly lives past 80 years, published C2 fracture morbidity\/mortality profiles in younger cohorts (55+) have become less applicable to octogenarians.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>OBJECTIVE:<\/jats:bold>\n                    To report associations between surgery and mortality, hospital length of stay and discharge disposition in octogenarians with traumatic C2 fractures.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>METHODS:<\/jats:bold>\n                    Retrospective cohort study of 3847 patients age \u2265 80 years representing 17 702 incidents nationwide, divided into surgery\/nonsurgery cohorts, using the National Sample Program of the National Trauma Data Bank from 2003 to 2012. Inpatient complications, mortality, length of stay, and discharge disposition are characterized; multivariable regression was utilized to determine associations between surgery and outcomes.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Institutional Review Board (IRB):<\/jats:bold>\n                    The National Sample Program dataset from the National Trauma Data Bank is fully deidentified and does not contain Health Insurance Portability and Accountability Act identifiers; therefore, this study is exempt from IRB review at the University of California, San Francisco.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    Incidence of surgery was 10.3%. Surgery was associated with increased pneumonia, acute respiratory distress syndrome, and decubitus ulcer risks (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .001). Inpatient mortality was 12.8% (nonsurgery\u201413.0%; surgery\u201410.3%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = .120). Length of stay was 8.31 \u00b1 9.32 days (nonsurgery 7.78 \u00b1 9.21; surgery 12.86 \u00b1 9.07;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .001) and showed an adjusted mean increase of 5.68 days with surgery (95% confidence interval [4.74-6.61]). Of patients surviving to discharge, 26% returned home (nonsurgery\u201426.8%; surgery\u201418.8%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = .001); surgery patients were less likely to return home (odds ratio 0.59 [0.44-0.78]).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>CONCLUSION:<\/jats:bold>\n                    The present study confirms that surgery of traumatic C2 fractures in octogenarians does not significantly affect inpatient mortality and increases discharge to institutionalized care. Patients undergoing surgery are more likely to require longer hospitalization and suffer increased medical complications during their stay. Given the retrospective nature of this study, it is unclear whether these conclusions reflect differences in injury severity between surgery cohorts. This question may be considered in a future prospective study.\n                  <\/jats:p>","DOI":"10.1093\/neuros\/nyw168","type":"journal-article","created":{"date-parts":[[2017,3,24]],"date-time":"2017-03-24T09:08:11Z","timestamp":1490346491000},"page":"854-862","source":"Crossref","is-referenced-by-count":39,"title":["Morbidity and Mortality Associated with Surgery of Traumatic C2 Fractures in Octogenarians"],"prefix":"10.1227","volume":"80","author":[{"given":"Sanjay S.","family":"Dhall","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ethan A.","family":"Winkler","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T.","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phiroz E.","family":"Tarapore","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, San Francisco, California"},{"name":"Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,6]]},"reference":[{"issue":"10","key":"bib1-20231012","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1097\/00007632-200005150-00006","article-title":"Management of type II dens fractures: a case-control study","volume":"25","author":"Lennarson","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"bib2-20231012","first-page":"1089","article-title":"Anterior screw fixation in type II odontoid fractures: Is there a difference in outcome between age groups?","volume":"52","author":"B\u00f6rm","year":"2003","journal-title":"Neurosurgery"},{"issue":"1","key":"bib3-20231012","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3171\/2009.7.SPINE08589","article-title":"Anterior fixation of odontoid fractures in an elderly population","volume":"12","author":"Dailey","year":"2010","journal-title":"J Neurosurg Spine"},{"issue":"1","key":"bib4-20231012","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/01.ta.0000197426.72261.17","article-title":"Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures","volume":"60","author":"Tashjian","year":"2006","journal-title":"J Trauma"},{"issue":"3","key":"bib5-20231012","first-page":"583","article-title":"Odontoid fractures in the elderly: Should we operate?","volume":"68","author":"Fagin","year":"2010","journal-title":"J Trauma"},{"issue":"9 suppl","key":"bib6-20231012","doi-asserted-by":"crossref","first-page":"S146","DOI":"10.1097\/BRS.0b013e3181d830a4","article-title":"Morbidity and mortality related to odontoid fracture surgery in the elderly population","volume":"35","author":"White","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"bib7-20231012","first-page":"83","article-title":"Odontoid fractures in the elderly: dorsal C1\/C2 fusion is superior to halo-vest immobilization","volume":"63","author":"Frangen","year":"2007","journal-title":"J Trauma"},{"issue":"8","key":"bib8-20231012","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1097\/BSD.0b013e318163570b","article-title":"Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study","volume":"21","author":"Smith","year":"2008","journal-title":"J Spinal Disord Tech"},{"issue":"1","key":"bib9-20231012","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3171\/jns.1993.78.1.0032","article-title":"Odontoid fractures in elderly patients","volume":"78","author":"Hanigan","year":"1993","journal-title":"J Neurosurg"},{"issue":"1","key":"bib10-20231012","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/0020-1383(92)90123-A","article-title":"The epidemiology of fractures and fracture-dislocations of the cervical spine","volume":"23","author":"Ryan","year":"1992","journal-title":"Injury"},{"issue":"4","key":"bib11-20231012","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1007\/s00586-008-0603-3","article-title":"Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients","volume":"17","author":"Malik","year":"2008","journal-title":"Eur Spine J"},{"key":"bib12-20231012","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1186\/1471-2482-13-54","article-title":"Treatment modality in type II odontoid fractures defines the outcome in elderly patients","volume":"13","author":"Scheyerer","year":"2013","journal-title":"BMC Surg"},{"issue":"13","key":"bib13-20231012","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1097\/BRS.0b013e318286f0cf","article-title":"The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up","volume":"38","author":"Chapman","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"issue":"12","key":"bib15-20231012","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1016\/j.spinee.2013.03.024","article-title":"Patient demographics, insurance status, race, and ethnicity as predictors of morbidity and mortality after spine trauma: a study using the National Trauma Data Bank","volume":"13","author":"Schoenfeld","year":"2013","journal-title":"Spine J"},{"issue":"5","key":"bib16-20231012","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"issue":"13","key":"bib17-20231012","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/BRS.0000000000000883","article-title":"Analysis of delays to surgery for cervical spinal cord injuries","volume":"40","author":"Samuel","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"bib18-20231012","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1097\/BRS.0000000000000756","article-title":"Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality","volume":"40","author":"Samuel","year":"2015","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"bib19-20231012","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2015.7.FOCUS15270","article-title":"Perioperative morbidity and mortality after lumbar trauma in the elderly","volume":"39","author":"Winkler","year":"2015","journal-title":"Neurosurg Focus"},{"issue":"suppl 2","key":"bib20-20231012","first-page":"123","article-title":"Management of isolated fractures of the axis in adults","volume":"72","author":"Ryken","year":"2013","journal-title":"Neurosurgery"},{"issue":"6","key":"bib21-20231012","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/BSD.0b013e31825d97c4","article-title":"Mortality in elderly patients following operative and nonoperative management of odontoid fractures","volume":"27","author":"Woods","year":"2014","journal-title":"J Spinal Disord Tech"},{"issue":"21S","key":"bib22-20231012","doi-asserted-by":"crossref","first-page":"S219","DOI":"10.1097\/BRS.0b013e3181f32716","article-title":"Optimal treatment for odontoid fractures in the elderly","volume":"35","author":"Harrop","year":"2010","journal-title":"Spine (Phila Pa 1976)"},{"issue":"8","key":"bib23-20231012","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/BSD.0b013e3181cc43c7","article-title":"Trends in epidemiology and management of type II odontoid fractures: 20-year experience at a model system spine injury tertiary referral center","volume":"23","author":"Smith","year":"2010","journal-title":"J Spinal Disord Tech"},{"issue":"4","key":"bib24-20231012","doi-asserted-by":"crossref","first-page":"E19","DOI":"10.3171\/2015.1.FOCUS14825","article-title":"National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups","volume":"38","author":"Kukreja","year":"2015","journal-title":"Neurosurg Focus"},{"issue":"6","key":"bib25-20231012","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1007\/s10654-010-9461-5","article-title":"Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital","volume":"25","author":"Jansson","year":"2010","journal-title":"Eur J Epidemiol"},{"issue":"12","key":"bib26-20231012","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1016\/j.injury.2012.04.008","article-title":"Epidemiology of spinal fractures among the elderly in Chongqing, China","volume":"43","author":"Wang","year":"2012","journal-title":"Injury"},{"issue":"6","key":"bib27-20231012","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1056\/NEJMoa0900429","article-title":"A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures","volume":"361","author":"Buchbinder","year":"2009","journal-title":"N Engl J Med"},{"issue":"14","key":"bib28-20231012","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1097\/00007632-200107150-00026","article-title":"Initial outcome and efficacy of \"kyphoplasty\" in the treatment of painful osteoporotic vertebral compression fractures","volume":"26","author":"Lieberman","year":"2001","journal-title":"Spine (Phila Pa 1976)"},{"key":"bib29-20231012","first-page":"f6234","article-title":"The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials","volume":"347","author":"El-Khoury","year":"2013","journal-title":"BMJ"},{"issue":"14","key":"bib30-20231012","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1001\/archinte.160.14.2145","article-title":"Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons","volume":"160","author":"Kannus","year":"2000","journal-title":"Arch Intern Med"},{"issue":"2","key":"bib31-20231012","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1097\/BSD.0b013e3181723d1b","article-title":"Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis","volume":"22","author":"Omeis","year":"2009","journal-title":"J Spinal Disord Tech"},{"issue":"5","key":"bib32-20231012","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1007\/s005860050188","article-title":"Management of odontoid fractures in the elderly","volume":"8","author":"M\u00fcller","year":"1999","journal-title":"Eur Spine J"},{"issue":"2","key":"bib33-20231012","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/00002517-199504000-00013","article-title":"Management of type II odontoid process fractures in geriatric patients; a prospective study of sequential cohorts with attention to survivorship","volume":"8","author":"Bednar","year":"1995","journal-title":"J Spinal Disord"},{"issue":"6","key":"bib34-20231012","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1046\/j.1532-5415.2001.49155.x","article-title":"Death at home following a targeted advance-care planning process at home: the kitchen table discussion","volume":"49","author":"Ratner","year":"2001","journal-title":"J Am Geriatr Soc"},{"issue":"12","key":"bib35-20231012","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1016\/j.socscimed.2003.09.005","article-title":"Place of death: preferences among cancer patients and their carers","volume":"58","author":"Thomas","year":"2004","journal-title":"Soc Sci Med"},{"key":"bib36-20231012","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1472-684X-12-7","article-title":"Heterogeneity and changes in preferences for dying at home: a systematic review","volume":"12","author":"Gomes","year":"2013","journal-title":"BMC Palliat Care"},{"issue":"9","key":"bib37-20231012","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1007\/s00268-013-2084-8","article-title":"Patients' preferences on information and involvement in decision making for gastrointestinal surgery","volume":"37","author":"Uldry","year":"2013","journal-title":"World J Surg"},{"key":"bib38-20231012","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13049-015-0099-x","article-title":"Emergency surgery in the elderly: the balance between function, frailty, fatality and futility","volume":"23","author":"S\u00f8reide","year":"2015","journal-title":"Scand J Trauma Resusc Emerg Med"},{"issue":"33","key":"bib39-20231012","doi-asserted-by":"crossref","first-page":"5275","DOI":"10.1200\/JCO.2007.11.1922","article-title":"Desire for information and involvement in treatment decisions: elderly cancer patients' preferences and their physicians' perceptions","volume":"25","author":"Elkin","year":"2007","journal-title":"J Clin Oncol"},{"issue":"2","key":"bib40-20231012","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/0272989X13508008","article-title":"Participation of very old adults in health care decisions","volume":"34","author":"Bynum","year":"2014","journal-title":"Med Decis Making"}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/neurosurgery\/article-pdf\/80\/6\/854\/32600577\/nyw168.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/00006123-201706000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:47:24Z","timestamp":1786121244000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00006123-201706000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,23]]},"references-count":39,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1093\/neuros\/nyw168","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,23]]}}}