PMID- 33724051 OWN - NLM STAT- MEDLINE DCOM- 20220318 LR - 20220318 IS - 1557-9042 (Electronic) IS - 0897-7151 (Linking) VI - 39 IP - 3-4 DP - 2022 Feb TI - Earlier Surgery Reduces Complications in Acute Traumatic Thoracolumbar Spinal Cord Injury: Analysis of a Multi-Center Cohort of 4108 Patients. PG - 277-284 LID - 10.1089/neu.2020.7525 [doi] AB - 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 h. To address this knowledge gap, we conducted an observational cohort study using data from the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) from 2010 to 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. Across 354 trauma centers 4108 adult TLSCI patients who underwent surgery were included. Median time-to-surgery was 18.8 h (interquartile range [IQR]: 7.4-40.9 h). The spline model suggests the risk of major complication rises consistently after a 12-h surgical wait-time. After propensity score matching, the odds of major complication were significantly lower for those receiving surgery within 12 h (odds ratio [OR] 0.77, 95% confidence interval [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). Although surgery within 12 h may not always be feasible, these data suggest that whenever possible surgeons should strive to reduce the amount of time between hospital arrival and surgical intervention, and health care systems should support this endeavor. FAU - Balas, Michael AU - Balas M AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Guttman, Matthew P AU - Guttman MP AD - Division of General Surgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Badhiwala, Jetan H AU - Badhiwala JH AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Lebovic, Gerald AU - Lebovic G AD - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. AD - Institute of Health Policy Management and Evaluation, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Nathens, Avery B AU - Nathens AB AD - Division of General Surgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. AD - Trauma Quality Programs, American College of Surgeons, Chicago, Illinois, USA. FAU - da Costa, Leodante AU - da Costa L AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada. FAU - Zador, Zsolt AU - Zador Z AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Spears, Julian AU - Spears J AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Fehlings, Michael G AU - Fehlings MG AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Wilson, Jefferson R AU - Wilson JR AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. AD - Institute of Health Policy Management and Evaluation, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. FAU - Witiw, Christopher D AU - Witiw CD AD - Division of Neurosurgery, Department of Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. AD - Institute of Health Policy Management and Evaluation, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. AD - Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. LA - eng PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20210426 PL - United States TA - J Neurotrauma JT - Journal of neurotrauma JID - 8811626 SB - IM MH - Adult MH - *Decompression, Surgical MH - Female MH - Hospitals MH - Humans MH - Lumbar Vertebrae/*injuries MH - Male MH - Retrospective Studies MH - Spinal Cord Injuries/*surgery MH - Thoracic Vertebrae/*injuries MH - Time-to-Treatment/*statistics & numerical data MH - *Treatment Outcome OTO - NOTNLM OT - early surgery OT - spinal cord injury OT - thoracolumbar OT - trauma EDAT- 2021/03/17 06:00 MHDA- 2022/03/19 06:00 CRDT- 2021/03/16 12:20 PHST- 2021/03/17 06:00 [pubmed] PHST- 2022/03/19 06:00 [medline] PHST- 2021/03/16 12:20 [entrez] AID - 10.1089/neu.2020.7525 [doi] PST - ppublish SO - J Neurotrauma. 2022 Feb;39(3-4):277-284. doi: 10.1089/neu.2020.7525. Epub 2021 Apr 26.