Timing of Surgery for Thoracolumbar Spine Trauma
| Autor: | Jack H. Ruddell, Alan H. Daniels, J. Mason DePasse, Oliver Y. Tang |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Population 03 medical and health sciences Postoperative Complications 0302 clinical medicine Hematoma medicine Humans Orthopedics and Sports Medicine education Retrospective Studies Inpatients 030222 orthopedics education.field_of_study Cervical fracture business.industry Lumbosacral Region Retrospective cohort study Odds ratio medicine.disease Confidence interval Surgery Spinal Fusion Spinal Fractures Injury Severity Score Neurology (clinical) Diagnosis code business 030217 neurology & neurosurgery |
| Zdroj: | Clinical Spine Surgery: A Spine Publication. 34:E229-E236 |
| ISSN: | 2380-0186 |
| Popis: | Study design Large multicenter retrospective cohort study. Objective The objective of this study was to analyze the effect of fusion timing on inpatient outcomes in a nationally representative population with thoracolumbar fracture and concurrent neurological injury. Summary of background data Among thoracolumbar trauma admissions, concurrent neurological injury is associated with greater long-term morbidity. There is little consensus on optimal surgical timing for these patients; previous investigations fail to differentiate thoracolumbar fracture with and without neurological injury. Materials and methods We analyzed 19,136 nonelective National Inpatient Sample cases (2004-2014) containing International Classifications of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for closed thoracic/lumbar fracture with neurological injury and procedure codes for primary thoracolumbar/lumbosacral fusion, excluding open/cervical fracture. Timing classification from admission to fusion was same-day, 1-2-, 3-6-, and ≥7-day delay. Primary outcomes included in-hospital mortality, complications, and infection; secondary outcomes included total and postoperative length of stay and charges. Logistic regressions and generalized linear models with gamma distribution and log-link evaluated the effect of surgical timing on primary and secondary outcomes, respectively, controlling for age, sex, fracture location, fusion approach, multiorgan system injury severity score, and medical comorbidities. Results Patients undergoing surgery ≤72 hours (n=12,845) had the lowest odds of in-hospital cardiac [odds ratio (OR)=0.595; 95% confidence interval (CI), 0.357-0.991] and respiratory complications (OR=0.495; 95% CI, 0.313-0.784) and infection (OR=0.615; 95% CI, 0.390-0.969). No differences were observed between same-day (n=4724) and 1-2-day delay (n=8121) (P>0.05). Lowest odds of hemorrhage or hematoma was observed following 3-6-day delay (OR=0.467; 95% CI, 0.236-0.922). A ≥7-day delay to fusion (n=2,002) was associated with greatest odds of hemorrhage/hematoma (OR=2.019; 1.107-3.683), respiratory complications (OR=1.850; 95% CI, 1.076-3.180), and infection (OR=3.155; 95% CI, 1.891-5.263) and greatest increases in mean postoperative length of stay (4.26% or 35.3% additional days) and charges (163,562 or 71.7% additional US dollars) (P Conclusions Patients with thoracolumbar fracture and associated neurological injury who underwent surgery within 3 days of admission experienced fewer in-hospital complications. These benefits may be due to secondary injury mechanism avoidance and earlier mobilization. Level of evidence Level III. |
| Databáze: | OpenAIRE |
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