The incidence of spinal cord injury (SCI) has increased in recent years, likely associated with population aging. The mechanism of SCI can be classified as traumatic or non-traumatic [1]. Traumatic causes of SCI include traffic accidents, falls, violence, and sports injuries; non-traumatic causes of SCI include intradural tumors, epidural hematomas, epidural abscesses, metastatic disease with epidural spinal cord compression, and surgical complications [2,3]. In the growing older adult population, the median age of patients with initial traumatic SCI (tSCI) has increased, and falls are the leading cause of SCI in patients aged over 65 years [4]. Decompression is the usual surgical treatment for tSCI followed by instrumentation for postoperative stabilization [5]. Given the higher prevalence of comorbidities in older adults, including conditions like respiratory disease, dementia, cerebrovascular disease, and cardiovascular disease, there is a need to consider non-surgical options when assessing patients with these comorbidities, as they can increase the risk of perioperative complications and short-term postoperative mortality [6].

Clinical care of patients with tSCI is typically complex and the sequelae of systemic injury are common. People with tSCI often experience chronic functional impairment and disability [7]. Pathophysiological changes in patients with tSCI may lead to systemic hypotension, cardiorespiratory dysfunction, and increased susceptibility to infection. In general, tSCI patients have a high rate of readmission in the first year after injury [8].

Globally, the age range of patients who experience tSCI has shifted. While most people with tSCI have typically been aged 16–30 years, the number of individuals over age 70 years has been increasing gradually [9]. For an individual who is injured at age 25, lifetime direct care costs for tSCI treatment can range from $2.1 to $5.4 million, and those costs are reported to be rising [10]. Accordingly, as the life expectancy of tSCI patients increases, the cost of care will also increase.

A previous study reported that by 2023, the majority of new cases of tSCI will be over age 70 years [11]. Age-related cognitive impairment, mobility, coordination deterioration-related medications and cumulative medical problems increase the risk of SCI [12]. As such, along with comorbidities that complicate treatment for tSCI, chronological age becomes the most clinically important factor influencing treatment decisions for patients with tSCI [13]. A previous study specifically reported less frequent surgery in elderly patients and a longer hospital LOS after admission [14]. Our previous study, which also evaluated 10 years of data from the National Inpatient Sample (NIS), found that age >65 years was the strongest predictor of in-hospital mortality following tSCI regardless of the injury sites [15]. However, predictive factors associated with short-term mortality in hospitalized older adults with tSCI have not been comprehensively evaluated. Therefore, this study aimed to determine risk factors for poor in-hospital outcomes in older adult patients with acute non-traffic tSCI in a large nationally representative cohort.