Postdoctoral Research Fellow University of Wisconsin-Madison
Introduction: Odontoid fractures of the C2 (axis) dens are common in low-energy falls in elderly and high-energy trauma in younger patients.
Methods: This retrospective analysis of data from the National Inpatient Sample from 2010 to 2020 examined White, Black, and Hispanic patients with odontoid fractures who received operative or non-operative treatment.
Results: 105,194 white, 7866 black, and 6930 Hispanic. White patients received operative treatment (56.49% in 2010 vs.84.30% in 2020), and non-operative treatment (43.51% in 2010vs. 15.70% in 2020), Black patients (42.30% vs.79.49% - 57.70% vs. 20.51%), and Hispanic (54.16% vs.70.97% - 45.84% vs. 29.03%), P < 0.001. Mean age was 69Y vs. 62Y for white, 51 vs. 43 for Black, and 57 vs 49 for Hispanic (P < 0.001). Mean Length of stay was 8 days vs. 7 in white, 9 vs. 8 for black, and 9 vs 7 for Hispanic (P < 0.001). White patients over 80 years old had the highest proportion of operative vs. non-operative treatment (33% vs 24%, p< 0.001), followed by 70–79 years old (27% vs 18%). Black and Hispanic under-50 had the highest surgery rates (45% vs. 57%, 38% vs 52%, P=0.01). All odontoid fracture patients had lower mortality rates from 2010 to 2020 (3.66% vs. 2.99%, trend p value = 0.027). Patients who received operative and non-operative treatment had stable mortality rates (2.62% in 2010 vs. 3.04% in 2020, trend p=0.347, 2.71% in 2010 vs 1.04% in 2020, trend p=0.122). whites had a higher odd of developing most complications, while black developed pulmonary, git, vascular injury, neurological injury and Hispanic developed pulmonary, git, neurological injury, mechanical injury and hematoma/ hemorrhage. Patients who received operative and non-operative treatment had stable mean LOS trends (9.05 days in 2010 vs. 8.77 days in 2020, trend P value=0.830, 7.43 in 2010 vs 8.33 in 2020, trend 0.665).After adjusting for inflation, mean total charges for operative and non-operative treatment increased significantly (143,970$ in 2010 vs. 196,816$ in 2020, trend P value < 0.0001, 95,371$ in 2010 vs 144,299$ in 2020, trend p value =0.003).
Conclusion : This study shows a national paradigm shift in odontoid fracture management for White, Black, and Hispanic patients over time.
