Older Patients With Spinal Cord Injuries Less Likely to Receive Surgery

New research from St. Michael’s Hospital in Toronto is indicating that older patients with traumatic spinal cord injuries are less likely to receive surgery compared with younger patients. And the bad news doesn’t end there…these patients also experience a significant lag between injury and surgery.

The research team utilized data from the Rick Hansen Spinal Cord Injury Registry, a database containing information on 1, 440 individuals who had a traumatic spinal cord injury. Of the total, 167 (11.7%) were aged 70 years or older.

According to the July 6, 2015 news release, “These patients were more likely to have fallen compared with younger patients (83.1% vs. 37.4%) and to have a longer stay in an acute care hospital, according to the paper published today in the Canadian Medical Association Journal. Younger patients were more likely to have severe injuries resulting in paralysis below the trauma site whereas older patients had less severe injuries. The time between injury to arrival at an acute care center was about twice as long for older patients than younger patients. Once admitted, older patients also waited about twice as long for surgery as younger patients.”

“These delays may be due to delays in recognizing the less severe injuries in seniors or they may reflect a potential age related therapeutic bias, ” said study author Dr. Henry Ahn.

The researchers also found that older patients were also significantly more likely to die from a traumatic spinal cord injury than younger people. “These significant differences in injury demographics, timing of surgery and outcomes in older compared with younger patients necessitates rethinking the management of traumatic spinal cord injury in those in the oldest age group, ” Dr. Ahn said.

Dr. Ahn told OTW, “We were surprised with where the delays in treatment occurred. Elderly patients, on average, took twice as long to get transferred to a spinal center compared to a younger patient. These delays can hinder timely care for these patients, during which time patients are often immobilized, increasing their risks of adverse events such as blood clots and pneumonia related to being immobilized. The study did not assess exactly why these delays occurred. Recent studies have shown early surgery maybe better for neurologic recovery in patients with incomplete cervical spinal cord injuries.”

As for how long it might take before this could be available for widespread use, Dr. Ahn commented to OTW, “Future studies are being set up to plot out factor affecting transfer times and timing for surgery in hospital. From this, specific interventions such as education and guideline changes can be implemented.”