34. Timing of surgery for thoracolumbar spine trauma: patients without neurological injury

BACKGROUND CONTEXT Over 100,000 thoracolumbar fractures occur annually in North America, with presence of concurrent neurological injury associated with greater long-term morbidity and unemployment. Previous investigations document heterogeneity in timing-outcome studies for thoracolumbar fracture, with most studies failing to differentiate patients with neurological injury from those without. PURPOSE This study analyzes the effect of time from hospital admission to spinal fusion on mortality, in-hospital complications, length of stay (LOS), and hospital charges in a large population of thoracolumbar fracture patients with neurological injury. STUDY DESIGN/SETTING Retrospective cohort study of de-identified National Inpatient Sample data from 2004-2014. PATIENT SAMPLE Nonelective cases containing ICD-9-CM diagnosis codes for closed thoracic/lumbar spinal fracture with concurrent neurological injury (806.20-806.29, 806.4) and procedure codes for primary thoracolumbar/lumbosacral fusion (81.04-81.08). Patients with diagnosis codes for any open, cervical, or sacral spinal fractures or any neurological injury of a non-thoracolumbar region were excluded. OUTCOME MEASURES In-hospital mortality and complications were primary measures. Inpatient surgical complication subtypes included all complications, cardiac complications, intraoperative hemorrhage or hematoma formation, respiratory complications, and postoperative infections. In 19,136 patients analyzed, patients undergoing surgery within 72 hours (n=12,845) had the lowest odds of in-hospital complications (OR=0.834; 95% CI, 0.697-0.999), cardiac complications (OR=0.573; 95% CI, 0.350-0.937), respiratory complications (OR=0.442; 95% CI, 0.282-0.691), and postoperative infection (OR=0.573; 95% CI, 0.366-0.899). No significant differences in outcomes were observed between same-day surgery (n=4,724) and 1-2-day delay (n=8,121). A ≥7-day delay in thoracolumbar fusion (n=2,002) was associated with the greatest odds of intraoperative hemorrhage or hematoma formation (OR=2.471; 95% CI, 1.351-4.517), respiratory complications (OR=1.909; 95% CI, 1.125-3.241), and postoperative infection (OR=3.559; 95% CI, 2.162-5.859). Greater than 7-day delay to fusion was also associated with the highest total and postoperative LOS and total charges (all p METHODS Classification of time from hospital admission to fusion: Same-day, 1-2-day delay, 3-6-day delay, and ≥7-day delay. To reduce data confounding by patient health and stability status, validated injury severity scoring algorithm from the International Classification of Diseases Program for Injury Categorization was used. Survey-design-weighted logistic regressions were performed to assess the effect of surgical timing on the primary inpatient outcomes, controlling for age, sex, fusion approach, and multi-organ-system injury severity score. Using the same controls, survey-design-weighted linear regressions were performed to assess the effect of surgical timing on secondary inpatient outcomes. RESULTS In 19,136 patients analyzed, patients undergoing surgery within 72 hours (n=12,845) had the lowest odds of in-hospital complications (OR=0.834; 95% CI, 0.697-0.999), cardiac complications (OR=0.573; 95% CI, 0.350-0.937), respiratory complications (OR=0.442; 95% CI, 0.282-0.691), and postoperative infection (OR=0.573; 95% CI, 0.366-0.899). No significant differences in outcomes were observed between same-day surgery and 1-2-day delay. A ≥7-day delay in thoracolumbar fusion was associated with the greatest odds of intraoperative hemorrhage/hematoma (OR=2.471; 95% CI, 1.351-4.517), respiratory complications (OR=1.909; 95% CI, 1.125-3.241), and postoperative infection (OR=3.559; 95% CI, 2.162-5.859). Greater than 7-day delay to fusion was also associated with the highest total and postoperative LOS and total charges (all p CONCLUSIONS While timing of spinal fusion following thoracolumbar fracture with neurological injury was not associated with mortality, patients who underwent surgery in ≤3 days after admission experienced fewer in-hospital complications, including hemorrhage, hematoma, respiratory complications, and postoperative infection. These benefits may be due to secondary injury mechanism avoidance and earlier mobilization. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.