P157. Factors associated with mortality and complications following surgical management of cervical facet fractures

BACKGROUND CONTEXT Cervical facet fractures are a relatively common injury and comprise approximately 10% of all subaxial cervical spine fractures. The unique facet orientation of the cervical spine predisposes it to a higher risk of injury, with cervical facet fractures being a leading cause of instability. Jumped and perched facets are associated with high rates of neurologic injury and morbidity. PURPOSE To investigate factors associated with complications for patients with unstable cervical facet(s) fractures treated with surgery. STUDY DESIGN/SETTING Retrospective review. Level of Evidence III. PATIENT SAMPLE Using a divisional database at a level I trauma center, 79 patients with cervical facet fractures were treated surgically by four surgeons from June 2001 to July 2022. OUTCOME MEASURES Complications and comorbidities associated with surgically treated cervical facet(s) fractures. METHODS Demographic variables including age, sex, race/ethnicity, fracture morphology (jumped facet, perched facet, facet fracture, unilateral/bilateral jumped), level of injury, mechanism of injury, type of surgical intervention, intraop and postop complications were collected. The neurological exam upon presentation was also evaluated. Statistical analysis with multi-logistic regression analysis was used to identify predictors of sustaining a post-op complication. Significance was set at P<0.05. RESULTS The mean age was 48.7 (SD 20.2) and BMI was 26.1 (SD 5.9). A total of 71% were males, and 13.9% were non-white; 33.3% of patients had bilateral facet fractures, 59.5% had a locked/perched facet. 3.9% were C3-4, 15.3% C4-5, 31.5% C5-6, 49.3% C6-7. 22 of the 79 patients (27.8%) sustained a postoperative complication. Also, 48.9% of complications were major complications with the most common being death and respiratory failure (25%), followed by sepsis, deep vein thrombosis, and neurogenic shock (13.3% each); the most common cause of death was cardiac arrest; 48.9% were minor complications with the most common being pneumonia and 2.2% were surgical with the only one being subluxation status-post ACDF; 20.5% had a spinal cord injury and of these 8.9% were classified as grade A, 6.3% B, 1.5% C, and 3.8% D on the American Spinal Injury Association Impairment Scale. Additionally, 57.5% of patients had anterior, 36.2% posterior, and 6.3% both approaches performed. A significant difference was found between the two cohorts (complication vs no-complication) for estimated blood loss (P=0.02), hospital length of stay (P=0.001), Bilateral vs Uni-lateral Facet Fracture (P=0.001), and presence of a spinal cord injury (SCI). Multi-logistic Regression analysis demonstrated that older age (OR 1.21; 95CI 1.02-1.44; P=0.03) and higher BMI (OR 1.65; 95CI 1.0 6-2.58; P=0.03) had an increased chance of sustaining a complication. Patients with unilateral facet fracture (OR 0.01; 95CI 0.01-0.68; P=0.04) had decreased odds of sustaining a complication. Delirium, cardiac arrest/arrhythmia, and pneumonia were the most frequent complications. CONCLUSIONS Patients undergoing operative management of cervical facet fractures had a 27.8% risk of complication with 97.8% being medical complications. Older age, higher BMI, and bilateral facet fracture led to an increased odds of sustaining a complication. The presence of locked/perched facets did not significantly impact the complication rate. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Cervical facet fractures are a relatively common injury and comprise approximately 10% of all subaxial cervical spine fractures. The unique facet orientation of the cervical spine predisposes it to a higher risk of injury, with cervical facet fractures being a leading cause of instability. Jumped and perched facets are associated with high rates of neurologic injury and morbidity. To investigate factors associated with complications for patients with unstable cervical facet(s) fractures treated with surgery. Retrospective review. Level of Evidence III. Using a divisional database at a level I trauma center, 79 patients with cervical facet fractures were treated surgically by four surgeons from June 2001 to July 2022. Complications and comorbidities associated with surgically treated cervical facet(s) fractures. Demographic variables including age, sex, race/ethnicity, fracture morphology (jumped facet, perched facet, facet fracture, unilateral/bilateral jumped), level of injury, mechanism of injury, type of surgical intervention, intraop and postop complications were collected. The neurological exam upon presentation was also evaluated. Statistical analysis with multi-logistic regression analysis was used to identify predictors of sustaining a post-op complication. Significance was set at P<0.05. The mean age was 48.7 (SD 20.2) and BMI was 26.1 (SD 5.9). A total of 71% were males, and 13.9% were non-white; 33.3% of patients had bilateral facet fractures, 59.5% had a locked/perched facet. 3.9% were C3-4, 15.3% C4-5, 31.5% C5-6, 49.3% C6-7. 22 of the 79 patients (27.8%) sustained a postoperative complication. Also, 48.9% of complications were major complications with the most common being death and respiratory failure (25%), followed by sepsis, deep vein thrombosis, and neurogenic shock (13.3% each); the most common cause of death was cardiac arrest; 48.9% were minor complications with the most common being pneumonia and 2.2% were surgical with the only one being subluxation status-post ACDF; 20.5% had a spinal cord injury and of these 8.9% were classified as grade A, 6.3% B, 1.5% C, and 3.8% D on the American Spinal Injury Association Impairment Scale. Additionally, 57.5% of patients had anterior, 36.2% posterior, and 6.3% both approaches performed. A significant difference was found between the two cohorts (complication vs no-complication) for estimated blood loss (P=0.02), hospital length of stay (P=0.001), Bilateral vs Uni-lateral Facet Fracture (P=0.001), and presence of a spinal cord injury (SCI). Multi-logistic Regression analysis demonstrated that older age (OR 1.21; 95CI 1.02-1.44; P=0.03) and higher BMI (OR 1.65; 95CI 1.0 6-2.58; P=0.03) had an increased chance of sustaining a complication. Patients with unilateral facet fracture (OR 0.01; 95CI 0.01-0.68; P=0.04) had decreased odds of sustaining a complication. Delirium, cardiac arrest/arrhythmia, and pneumonia were the most frequent complications. Patients undergoing operative management of cervical facet fractures had a 27.8% risk of complication with 97.8% being medical complications. Older age, higher BMI, and bilateral facet fracture led to an increased odds of sustaining a complication. The presence of locked/perched facets did not significantly impact the complication rate.