Earlier Surgery Reduces Complications in Acute Traumatic Thoracolumbar Spinal Cord Injury: Analysis of a Multicenter Cohort of 4,108 Patients.

Abstract

Early surgical intervention to decompress the spinal cord and stabilize the spinal column in patients with acute traumatic thoracolumbar spinal cord injury (TLSCI) may lessen the risk of developing complications and improve outcomes. However, there has yet to be agreement on what constitutes early surgery; reported thresholds range from 8 to 72 hours. To address this knowledge gap, we conducted an observational cohort study using data from the American College of Surgeons Trauma Quality Improvement Program between 2010-2016. The association between time from hospital arrival to surgical intervention and risk of major complications was assessed using restricted cubic splines. Propensity score matching was then used to assess the association between delayed surgery and risk of complications. 4,108 adult TLSCI patients across 354 trauma centers that underwent surgery were included. Median time-to-surgery was 18.8 hours (IQR: 7.4 to 40.9). The spline model suggests the risk of major complication rises consistently after a 12-hour surgical wait-time. After propensity score matching, the odds of major complication were significantly lower for those receiving surgery within 12 hours (OR 0.77, 95%CI: 0.64 to 0.94). This was also true for immobility-related complications (OR 0.79, 95%CI: 0.64 to 0.97). Patients in the early group spent 1.5 fewer days in the critical care unit on average (95%CI: -2.09 to -0.88). While surgery within 12 hours may not always be feasible, this data suggests that whenever possible surgeons should strive to reduce the amount of time between hospital arrival and surgical intervention, and healthcare systems should support this endeavor.