Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center

Thompson, Cynthia; Feldman, Debbie Ehrmann; Mac-Thiong, Jean-Marc

doi:10.1080/10790268.2016.1165448

Cited by 20 publications

(10 citation statements)

References 21 publications

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“…However, we noted a highly variable interfacility transport time (IQR of 4.3–40 h). Similar delays associated with an indirect admission have been reported in other tSCI studies in which the median wait time is 8–12 h, 10 , 12 , 14 and can be as long as 33 h. 15 Indirect admission could risk putting patients outside of the recommended 24 h post-injury time window to surgery, 9 , 24 especially older patients who have a significantly longer wait time from admission to surgery than younger patients (37 vs. 19 h). 38 …”

Section: Discussionsupporting

confidence: 66%

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Cheng

Noonan

Shurgold

et al. 2017

Journal of Neurotrauma

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Current research indicates that more than half of patients with traumatic spinal cord injury (tSCI) experience delays in transfer and receive surgery >24 h post-injury. The objectives of this study were to determine the geographic distribution of tSCI in Canada relative to specialized treatment facilities, to assess clinical and logistical factors at play for indirect admissions to those facilities, and to explore differences in current time to admission and simulated scenarios in an attempt to assess the potential impact of changes to triage protocols. This study included data from 876 patients with tSCI enrolled in the prospectively collected acute Rick Hansen Spinal Cord Injury Registry (RHSCIR) between January 1, 2010 and December 31, 2013 for whom there were data on the location of their injury. Patients transported directly to a RHSCIR acute facility were more likely to reach the facility within 1 h of injury, whereas those transported indirectly were more likely to arrive 7 h later. Considering the injuries occurring within 40 km of a RHSCIR acute facility (n = 323), 249 patients (77%) were directly and 74 (23%) were indirectly admitted. In the multivariate regression analysis, only older age and longer road distance remained significantly associated with being indirectly admitted to a RHSCIR facility. Compared with the current status, the median time to admission decreased by 20% (3.5 h) in the 100% direct admission scenario, and increased by 102% (8.9 h) in the 100% indirect admission scenario.

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Section: Discussionsupporting

confidence: 66%

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Cheng

Noonan

Shurgold

et al. 2017

Journal of Neurotrauma

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“…This observation highlights the fact that transfer to the specialized acute SCI-center do not delay surgical management. It may also underline the ability of a specialized multidisciplinary team to organize prompt evaluation, medical stabilization and surgical planning, while there are multiple barriers to early surgery [26,32]. However, the argument for earlier surgery in a nonspecialized center could still be considered in certain occasions for geographical reasons, and the influence of geographical distance on the need of early transfer to a SCI center should therefore be explored in a future study.…”

Section: Discussionmentioning

confidence: 99%

The impact of a specialized spinal cord injury center as compared with non-specialized centers on the acute respiratory management of patients with complete tetraplegia: an observational study

et al. 2017

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“…Earlier analyses documented lowest early surgery rates, whereas studies from more recent years had the highest early surgery rates [4,7,17-19]. Our study is the first, to our knowledge, to evaluate the year-to-year trend of early spinal decompression over the past two decades.…”

Section: Discussionmentioning

confidence: 81%

A Two-decade Assessment of Changing Practice for Surgical Decompression and Fixation after Traumatic Spinal Cord Injury – Impact on Healthcare Utilization and Cost

Ugiliweneza

Guest

Herrity

et al. 2019

Cureus

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Early surgery after traumatic spinal cord injury (TSCI) has been associated with a greater neurological recovery and reduced secondary complications. In this study, we aimed to evaluate the trend of early TSCI surgery (within 24 hours) over two decades and the effect on length of hospitalization, complications, and hospital charges. We extracted emergency admissions of adults diagnosed with TSCI from the National Inpatient Sample database (1998-2016). We analyzed the trend of early surgery and concurrent trends of complication rate, length of stay (LOS) and hospital charges. These outcomes were then compared between early and late surgery cohorts. There were 3942 (53%) TSCI patients who underwent early surgery, and 3446 (47%) were operated after 24 hours. The combined patient group characteristics consisted of median age 43 years (IQR: 29-59), 73% males, 72% white, 44% private payer, 18% Medicare, 17% Medicaid, 51% cervical, 30% thoracic, 75% from large hospitals, and 79% from teaching hospitals. The trend of early surgery, adjusted for annual case-mix, increased from 45% in 1998 to 64% in 2016. Each year was associated with 1.60% more patients undergoing early surgery than the previous year (p-value <0.05). During these years, the total LOS decreased, while hospital charges increased. Patients who underwent early surgery spent four fewer days in the hospital, accrued $28,705 lower in hospital charges and had 2.8% fewer complications than those with delay surgery. We found that the rate of early surgery has significantly increased from 1998 to 2016. However, as of 2016, one-third of patients still did not undergo spinal surgery within 24 hours. Late surgery is associated with higher complications, longer stays, and higher charges. The causes of delayed surgery are undoubtedly justified in some situations but require further delineation. Surgeons should consider performing surgery within 24 hours on patients with TSCI whenever feasible.

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Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center

Cited by 20 publications

References 21 publications

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

Geomapping of Traumatic Spinal Cord Injury in Canada and Factors Related to Triage Pattern

The impact of a specialized spinal cord injury center as compared with non-specialized centers on the acute respiratory management of patients with complete tetraplegia: an observational study

A Two-decade Assessment of Changing Practice for Surgical Decompression and Fixation after Traumatic Spinal Cord Injury – Impact on Healthcare Utilization and Cost

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