Incidence of dysphagia after odontoid screw fixation of type II odontoid fracture in the elderly

BACKGROUND: Although surgery may reduce mortality rates from type II odontoid fractures in the elderly population, post-operative dysphagia resulting from screw fixation remains a serious complication. METHODS: We retrospectively performed a chart review of patients over 65 years of age who underwent odontoid screw placement for type II odontoid fractures (2009-2014) and sustained post-operative dysphagia. The severity of dysphagia was determined based on the requirements for modified diets, PEG tubes, and prolonged length of stay (LOS), while costs were based upon discharge disposition (e.g. home vs. rehabilitation facilities) and total hospital costs. RESULTS: The incidence of postoperative dysphagia was 80%; 33% required feeding tubes, and 35% warranted PEG placement. The mean LOS for patients with dysphagia was 5 days longer and the total hospital costs averaged $50,000 higher. CONCLUSIONS: Age over 65 is a significant predictor of post-operative dysphagia in patients undergoing type II odontoid screw fixation. Notably, with each additional year above 65, the likelihood of post-operative dysphagia increased by 12%. Furthermore, postoperative dysphagia statistically increased the LOS and total costs.