P156. Mortality of operative spinal fractures in COVID-19 positive patients using data from a national database

BACKGROUND CONTEXT: The ever-evolving COVID-19 pandemic has presented critical surgical management challenges. Increases in COVID-19 positive patients and subsequently, patients sustaining spinal fractures who test positive for COVID-19, raises the question of whether these individuals are at an increased risk of mortality and subsequent complications. PURPOSE: The purpose of this study was to characterize the cohort of COVID-19-positive patients who required surgery following a spinal fracture and investigate if these patients are at increased risk of all-cause mortality and further complications. STUDY DESIGN/SETTING: Retrospective cohort study of prospectively collected data performed from March 15, 2020 to December 12, 2021 using a national database with clinical data from 56 sites. PATIENT SAMPLE: Patients with a diagnostic test for COVID-19, who sustained spinal fractures and required operative intervention. OUTCOME MEASURES: The primary outcome was all-cause mortality. Additional outcomes included acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE) and sepsis. METHODS: A total population of 8.4 million patients was examined using the National COVID Cohort Collaborative (N3C) data enclave. The N3C is a centralized national data resource that compiles data using electronic health care records from over 8 million patients. Inclusion criteria consisted of adults 18 years old or older with a diagnostic test for COVID-19, who sustained spinal fractures and required operative intervention. Patients' information from this database was collected and grouped according to lab-confirmed COVID-19-positive and negative testing which was acquired via the “SARS-CoV-2 RT-PCR and Antigen” test. Those who tested positive for COVID-19 were compared to a control group that was COVID-19-negative using the same standardized PCR and antigen testing methods. RESULTS: A total of 2,745 patients with operative spinal fractures were identified. A group of 207 (8%) patients tested COVID-19 positive at the time of surgery. At baseline, the groups were comparable in age (57 vs 58 years), gender (41% women in each group), body mass index (28 in each group), cervical spinal cord injury (9.8% vs 8.1%) and length of stay (8 days in each group) (all p>0.05). The COVID-19positive cohort had a higher all-cause mortality than the COVID-19 negative group (14% vs 7%, p<0.001). There were increased odds for AKI [1.62(1.15, 2.26)], ARDS [2.78(2.07, 3.73)], VTE [1.65(1.18, 2.30)], and sepsis [2.58(1.88,3.53)] [Odds Ratio (Lower Limit, Upper Limit)] in patients testing positive for COVID-19. CONCLUSIONS: This national analysis of operative spinal fractures and COVID-19 showed increased mortality and perioperative events (AKI, ARDS, VTE, Sepsis). Further research is needed to investigate potential interventions for testing and management related to COVID-19 in the context of operative spinal fractures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.