Investigating Geriatric Complete Cervical Spinal Cord Injury: Prognostic Factors for Inpatient Mortality and Morbidity

Introduction: Complete cervical spinal cord injury (cSCI) carries high mortality risks and often leads to severe functional impairment and dependency in survivors. While the prevalence of geriatric cSCI is rising, there is limited understanding of prognostic factors in this population compared to younger patients. This study addresses that gap by analyzing national data to guide clinical decision-making and improve management for older adults with complete cSCI.

Methods: We analyzed complete cSCI cases from the American College of Surgeons Trauma Quality Program database for patients aged 40 and over from 2019 to 2021, excluding those with severe head trauma or pre-hospital deaths. Clinical and demographic characteristics were compared between middle-aged (40–69) and geriatric (≥70) cohorts. Multivariate logistic and linear regression models were used within each cohort to identify predictors of mortality, complications, intensive care unit (ICU) stay, and ventilator use. Analyses were performed using Python 3.7 in Google Colab.

Results: Of the 1,147 patients, 798 were middle-aged, and 349 were geriatric. Mortality was significantly higher among geriatric patients (60.7% vs. 23.2%, p < 0.001), who also underwent surgery less often (59.9% vs. 81.0%, p < 0.001). Surgical management was associated with reduced mortality in both groups (geriatric: OR 0.2, p < 0.001; middle-aged: OR 0.2, p < 0.001). Complications were more frequent in middle-aged patients (47.6% vs. 36.4%, p < 0.001), with surgery being a key predictor of increased complication risk. Geriatric patients had shorter ICU stays (11.2 vs. 17.0 days, p < 0.001) and required less ventilator support (11.6 vs. 18.1 days, p < 0.001).

Conclusion : Geriatric patients with complete cSCI had higher mortality despite fewer complications, shorter ICU stays, and lower surgical rates. Surgery reduced geriatric mortality but increased complications, ICU stay, and ventilator use. Individualized care is recommended to ensure geriatric patients receive equitable surgical consideration.