Trends in management of odontoid fractures 2010–2021
Background Context: Odontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized. Purpose: To investigate the trends and predictive factors of surgical versus nonsurgical treatmen...
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Elsevier
2024-12-01
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| Series: | North American Spine Society Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666548424002464 |
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| author | Michael J. Gouzoulis, BS Anthony E. Seddio, BS Albert Rancu, BS Sahir S. Jabbouri, MD Jay Moran, MD Arya Varthi, MD Daniel R. Rubio, MD Jonathan N. Grauer, MD |
| author_facet | Michael J. Gouzoulis, BS Anthony E. Seddio, BS Albert Rancu, BS Sahir S. Jabbouri, MD Jay Moran, MD Arya Varthi, MD Daniel R. Rubio, MD Jonathan N. Grauer, MD |
| author_sort | Michael J. Gouzoulis, BS |
| collection | DOAJ |
| description | Background Context: Odontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized. Purpose: To investigate the trends and predictive factors of surgical versus nonsurgical treatment and anterior versus posterior stabilization of odontoid fractures. Study Design/Setting: Retrospective database cohort study. Patient Sample: Adult patients with odontoid fractures between 2010 and 2021. Outcome Measures: Yearly trends and predictors of odontoid fracture management. Methods: Adult patients with odontoid fractures were abstracted from the large, national, administrative M161Ortho Pearldiver dataset. For operative versus nonoperative care of odontoid fractures, yearly rates were determined (since 2016 based on coding limitations). For anterior versus posterior stabilization, yearly rates were determined (2010–2021). Univariate and multivariable analyses were performed for both sets of comparisons. Results: For assessment of nonsurgical versus surgical management from 2016 to 2021, a total of 42,754 patients with odontoid fracture were identified, of which surgical intervention was done for 7.9%. Predictive factors of surgical intervention included being managed by a neurosurgeon (OR:1.29), being from Midwest United States (OR:1.35 relative to West), male sex (OR:1.20), and decreasing age (OR: 0.82 per decade) (p < .001 for each). Of those undergoing surgical intervention, 33.6% had anterior surgery while 66.4% had posterior surgery (anterior surgery decreased from 36.4% in 2010 to 27.2% in 2021, p < .001). Predictive factors of undergoing anterior versus posterior approach include having a neurosurgeon surgeon (OR:1.98), being from the Southern (OR:1.61 relative to Northeast), and having Medicare insurance (OR: 1.31) (p < .001 for each). Conclusions: The overall rate of surgery for odontoid fractures has remained similar over the past years. Of those undergoing surgery, less are being done from anterior. While these decisions were predicted by some clinical factors, both also correlated with nonclinical factors suggesting room for more consistent algorithms. |
| format | Article |
| id | doaj-art-08e8ff37a70a4ad48bdbae05d5bcb982 |
| institution | Kabale University |
| issn | 2666-5484 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | North American Spine Society Journal |
| spelling | doaj-art-08e8ff37a70a4ad48bdbae05d5bcb9822024-12-18T08:53:10ZengElsevierNorth American Spine Society Journal2666-54842024-12-0120100553Trends in management of odontoid fractures 2010–2021Michael J. Gouzoulis, BS0Anthony E. Seddio, BS1Albert Rancu, BS2Sahir S. Jabbouri, MD3Jay Moran, MD4Arya Varthi, MD5Daniel R. Rubio, MD6Jonathan N. Grauer, MD7Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesDepartment of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesDepartment of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesDepartment of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesDepartment of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesDepartment of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesDepartment of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesCorresponding author: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, PO Box 208071, CT 06520-8071, New Haven, CT 06511, USA.; Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, United StatesBackground Context: Odontoid fractures are relatively common. However, the literature is unclear how these fractures are best managed in many scenarios. As such, care is varied and poorly characterized. Purpose: To investigate the trends and predictive factors of surgical versus nonsurgical treatment and anterior versus posterior stabilization of odontoid fractures. Study Design/Setting: Retrospective database cohort study. Patient Sample: Adult patients with odontoid fractures between 2010 and 2021. Outcome Measures: Yearly trends and predictors of odontoid fracture management. Methods: Adult patients with odontoid fractures were abstracted from the large, national, administrative M161Ortho Pearldiver dataset. For operative versus nonoperative care of odontoid fractures, yearly rates were determined (since 2016 based on coding limitations). For anterior versus posterior stabilization, yearly rates were determined (2010–2021). Univariate and multivariable analyses were performed for both sets of comparisons. Results: For assessment of nonsurgical versus surgical management from 2016 to 2021, a total of 42,754 patients with odontoid fracture were identified, of which surgical intervention was done for 7.9%. Predictive factors of surgical intervention included being managed by a neurosurgeon (OR:1.29), being from Midwest United States (OR:1.35 relative to West), male sex (OR:1.20), and decreasing age (OR: 0.82 per decade) (p < .001 for each). Of those undergoing surgical intervention, 33.6% had anterior surgery while 66.4% had posterior surgery (anterior surgery decreased from 36.4% in 2010 to 27.2% in 2021, p < .001). Predictive factors of undergoing anterior versus posterior approach include having a neurosurgeon surgeon (OR:1.98), being from the Southern (OR:1.61 relative to Northeast), and having Medicare insurance (OR: 1.31) (p < .001 for each). Conclusions: The overall rate of surgery for odontoid fractures has remained similar over the past years. Of those undergoing surgery, less are being done from anterior. While these decisions were predicted by some clinical factors, both also correlated with nonclinical factors suggesting room for more consistent algorithms.http://www.sciencedirect.com/science/article/pii/S2666548424002464Odontoid fractureAnterior screw fixationPosterior fusionPearldiverDatabase |
| spellingShingle | Michael J. Gouzoulis, BS Anthony E. Seddio, BS Albert Rancu, BS Sahir S. Jabbouri, MD Jay Moran, MD Arya Varthi, MD Daniel R. Rubio, MD Jonathan N. Grauer, MD Trends in management of odontoid fractures 2010–2021 North American Spine Society Journal Odontoid fracture Anterior screw fixation Posterior fusion Pearldiver Database |
| title | Trends in management of odontoid fractures 2010–2021 |
| title_full | Trends in management of odontoid fractures 2010–2021 |
| title_fullStr | Trends in management of odontoid fractures 2010–2021 |
| title_full_unstemmed | Trends in management of odontoid fractures 2010–2021 |
| title_short | Trends in management of odontoid fractures 2010–2021 |
| title_sort | trends in management of odontoid fractures 2010 2021 |
| topic | Odontoid fracture Anterior screw fixation Posterior fusion Pearldiver Database |
| url | http://www.sciencedirect.com/science/article/pii/S2666548424002464 |
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