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

Cervical spinal cord injuries (CSCIs) present challenges with potential severe neurological complications. Despite advances in care, in-hospital mortality remains a concern. This study explores the impact of patient-related factors and therapeutic strategies on in-hospital mortality in individuals with CSCIs. Retrospective cross-sectional study. Admissions with CSCIs recruited between January 2019 to December 2023. 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). 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. 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<0.001). 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<0.001). 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<0.001). Additionally, aspiration pneumonia and hospital-acquired pneumonia were linked to increased in-hospital mortality risk (OR 2.21, OR 1.52; p<0.001). 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.