Influence of Hospital Transfer Status on Surgical Outcomes for Traumatic Thoracolumbar Spine Fractures: Insights from a Multicenter Investigation.

Autor: Taghlabi KM; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA. Electronic address: ktaghlabi@houstonmethodist.org., Guerrero JR; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA., Bhenderu LS; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA., Xu J; Center for Health Data Science and Analytics, Department of Medicine, Houston Methodist Research Institute, Houston, Texas, USA., Nanda R; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA; School of Engineering Medicine, Texas A&M University, Houston, Texas, USA., Somawardana IA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA; School of Engineering Medicine, Texas A&M University, Houston, Texas, USA., Baradeiya AMA; Department of Emergency Medicine, DHR Health, Edinburg, Texas, USA., Tahanis A; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA., Cruz-Garza JG; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA., Freyvert Y; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA., Trask TW; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA., Huang M; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA., Barber SM; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA., Holman PJ; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA., Faraji AH; Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Oct; Vol. 190, pp. e637-e647. Date of Electronic Publication: 2024 Aug 03.
DOI: 10.1016/j.wneu.2024.07.197
Abstrakt: Objective: Surgical intervention for unstable thoracolumbar spine fractures is common, but delayed management and complications can impact outcomes. This study compares perioperative outcomes between patients directly admitted and those transferred from another facility for thoracolumbar spine surgery, aiming to identify predictors of complications and mortality.
Methods: A multicenter retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021 identified 61,626 patients undergoing fusion surgeries for thoracolumbar spine fractures, excluding spinal cord injury or pathological fractures. Patients were categorized as Direct (admitted from the emergency department) and Transfer (transferred from another facility). Perioperative outcomes, including operative time, length of stay (LOS), 30-day mortality, and complications, were compared.
Results: Our patient population (54.3% female, mean age 62.4 ± 12.9 years) comprised 12.2% Transfer and 87.8% Direct patients. Following propensity score matching, Transfer patients had a longer hospital LOS (5.1 ± 5.7 days vs. 4.5 ± 4.6 days, P < 0.001). Transfer exhibited higher rates of superficial incisional surgical site infection (1.7% vs. 1.1%, P = 0.003), sepsis (1.7% vs. 1.3%, P = 0.038), pneumonia (1.7% vs. 1.2%, P = 0.019), postoperative reintubation (0.9% vs. 0.6%, P = 0.036), and failure to wean off ventilator >48 hours postsurgery (0.7% vs. 0.3%, P = 0.005) compared to Direct admissions. Direct group had a higher rate of perioperative transfusion (16.5% vs. 13.4%, P < 0.001). Transfer patients also had a higher 30-day mortality rate compared to Direct admissions (1.1% vs. 0.6%, P = 0.002).
Conclusions: Interhospital transfers significantly affect hospital LOS, postoperative morbidity, and mortality in thoracolumbar spine surgery. Enhancing postoperative monitoring for transfer patients is crucial.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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