Risk factors for in-hospital mortality in cervical spinal cord injuries: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 3,847 cases

Abstract

Background context: Cervical spinal cord injuries (CSCIs) present challenges with potential severe neurological complications. Despite advances in care, in-hospital mortality remains a concern.

Purpose: This study explores the impact of patient-related factors and therapeutic strategies on in-hospital mortality in individuals with CSCIs.

Study design/setting: Retrospective cross-sectional study.

Patient sample: Admissions with CSCIs recruited between January 2019 and December 2023.

Outcome measures: Data from the German Diagnosis Related Groups (DRG) system were used to analyze main diagnoses, patient demographics, concomitant diagnoses (ICD-10), and procedures (OPS). Specific data were extracted from the database of the German Institute for the Hospital Remuneration System (InEK GmbH).

Methods: Differences in comorbidities and injuries were analyzed using the Chi-square test. Odds ratios (OR) were calculated to analyze potential risk factors for in-hospital mortality.

Results: In the analysis of 3.847 hospital admission cases, an in-hospital mortality rate of 11.7% (n=451) was observed. The patient cohort demonstrated a male predominance at 72.9%. The overall incidence of CSCI in Germany is 9.2 per million annually, with a significant increase in incidence rate observed with age, particularly after 60 years. The majority of admissions were aged over 65 years and this age group (>65 years) was identified as a significant risk factor for increased in-hospital mortality (n=2.064; OR 1.83; p<.001). Vertebral fractures at the levels C4 (n=364; 9.5%), C5 (n=582; 15.1%), and C6 (n=598; 15.5%) were the most common spinal injuries, while concomitant fractures at atlas (C1), axis (C2) and C7 fractures were associated with an elevated significant risk for in-hospital mortality (OR 2.40, OR=2.67, OR=2.21; p<.001). The need for blood transfusion was associated with a high in-hospital mortality rate of 31.3%. Amongst others, hypothermia, acute kidney failure, pleural effusion, and atrial fibrillation were significantly associated with in-hospital mortality (all p<.001). Additionally, aspiration pneumonia and hospital-acquired pneumonia were linked to increased in-hospital mortality risk (OR 2.21, OR 1.52; p<.001).

Conclusions: Concomitant injuries and comorbidities indicating frailty and medical complications increase in-hospital mortality risk. The study highlights the need for thorough health assessments in patients with CSCIs, encouraging personalized and optimized treatment strategies.

Keywords: Cervical spinal cord injury; Comorbidities; In-hospital mortality; Risk factors; Surgical techniques; Traumatic injuries.