As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are increasingly faced with difficult discussions regarding aggressiveness of management, likelihood of recovery, and survival. Our objective was to outline risk factors associated with in-hospital mortality in elderly surgical and non-surgical patients following tSCI and to determine those unlikely to have a favorable outcome. Data from elderly patients (≥ 65 years of age) in the Canadian Rick Hansen SCI Registry from 2004 to 2017 were analyzed using descriptive analysis. Survival and mortality groups in each of the surgical and non-surgical group were compared to explore factors associated with in-hospital mortality and their impact, using logistical regression. Of 1340 elderly patients, 1018 had surgical data with 826 having had surgery. In the surgical group, the median time to death post-injury was 30 days with 75% dying within 50 days compared with 7 days and 20 days, respectively, in the non-surgical group. Significant predictors for in-hospital mortality following surgery are age, comorbidities, neurological injury severity (American Spinal Injury Association [ASIA] Impairment Scale [AIS]), and ventilation status. The odds of dying 50 days post-surgery are six times higher for patients ≥77 years of age versus those 65–76 years of age, five times higher for those with AIS A versus those with AIS B/C/D, and seven times higher for those who are ventilator dependent. An expected probability of dying within 50 days post-surgery was determined using these results. In-hospital mortality in the elderly after tSCI is high. The trend with age and time to death and the significant predictors of mortality identified in this study can be used to inform clinical decision making and discussions with patients and their families.

中文翻译：

---

急性创伤性脊髓损伤老年人的院内死亡率。

随着老年人创伤性脊髓损伤 (tSCI) 的发病率上升，临床医生越来越多地面临关于治疗积极性、康复可能性和生存率的困难讨论。我们的目标是概述与 tSCI 后老年手术和非手术患者院内死亡率相关的风险因素，并确定那些不太可能有良好结果的因素。使用描述性分析对加拿大 Rick Hansen SCI 登记处 2004 年至 2017 年老年患者（≥65 岁）的数据进行分析。比较每个手术组和非手术组的存活率和死亡率组，以探索与院内死亡率及其影响相关的因素，使用逻辑回归。在 1340 名老年患者中，1018 名有手术数据，826 名做过手术。在手术组中，受伤后死亡的中位时间为 30 天，其中 75% 在 50 天内死亡，而非手术组分别为 7 天和 20 天。手术后院内死亡率的重要预测因素是年龄、合并症、神经损伤严重程度（美国脊髓损伤协会 [ASIA] 损伤量表 [AIS]）和通气状态。≥ 77 岁患者的术后 50 天死亡几率是 65-76 岁患者的 6 倍，AIS A 患者是 AIS B/C/D 患者的 5 倍，以及 7 倍对于依赖呼吸机的人来说更高。使用这些结果确定术后 50 天内死亡的预期概率。tSCI 后老年人的院内死亡率很高。