Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries

Abstract

There are limited data pertaining to current practices in timing of surgical decompression for acute thoracolumbar spinal cord injury (SCI). We conducted a retrospective cohort study to evaluate variability in timing between- and within-trauma centers in North America; and to identify patient- and hospital-level factors associated with treatment delay. Adults with acute thoracolumbar SCI who underwent decompressive surgery within five days of injury at participating trauma centers in the American College of Surgeons Trauma Quality Improvement Program were included. Mixed-effects regression with a random intercept for trauma center was used to model the outcome of time to surgical decompression and assess risk-adjusted variability in surgery timeliness across centers. 3,948 patients admitted to 214 TQIP centers were eligible. 28 centers were outliers, with a significantly shorter or longer time to surgery than average. Case-mix and hospital characteristics explained < 1% of between-hospital variability in surgical timing. Moreover, only 7% of surgical timing variability within-centers was explained by case-mix characteristics. The adjusted intraclass correlation coefficient of 12% suggested poor correlation of surgical timing for patients with similar characteristics treated at the same center. These findings support the need for further research into the optimal timing of surgical intervention for thoracolumbar SCI.

Assessment of the incremental prognostic value from the modified frailty index-5 in complete traumatic cervical spinal cord injury

“…Several patient and hospital covariates were selected from the TQIP database according to their clinical relevance as defined by prior studies 18 . Patient demographic data included age, mFI-5, sex, ethnicity, and insurance type.…”

“…Hospital size was categorized as < 200 beds, 200-400 beds, and > 400 beds. Variable categories were chosen largely based on prior studies 18 .…”

Overexpression of the X-linked Inhibitor of Apoptosis Protein (XIAP) in Neurons Improves Cell Survival and the Functional Outcome after Traumatic Spinal Cord Injury

“…States in 2012 only in treatments) [4]. Several promising therapies have been developed during the last three decades [4], but only early surgical decompression is routinely applied in clinical practice [5]. Among the pharmacological therapies available, only high doses of methylprednisolone sodium succinate have reached clinical practice with controversial results [4].…”

Spinal cord pathology revealed by MRI in traumatic spinal cord injury

“…preoperative cord compression of more than onethird of the cord diameter and, who underwent consecutive decompressive surgery, recover better than patients treated conservatively [19]. There is an ongoing debate on the effect of timing of surgical intervention for recovery following SCI [20][21][22]. Although decompression within the first 24 h following traumatic SCI seems to be associated with improved neurological recovery [21,22], preoperative IMLL and not timing of decompressive surgery predicts long-term neurological outcome in terms of AIS grade conversion following SCI [23].…”