Non-Neurological Outcomes after Complete Traumatic Spinal Cord Injury: The Impact of Surgical Timing

It remains unclear whether the benefits of early surgical timing are significant in neurologically complete spinal cord injury (SCI). We wanted to compare the effects of early and late surgical timing on non-neurological outcomes in persons with traumatic complete SCI. All cases of traumatic complete SCI referred to a single institution between 2000 and 2011 were retrospectively reviewed. The occurrence of pneumonia, urinary tract infection (UTI), pressure ulcer (PU), and all other postoperative complications were recorded. Cost of acute hospitalization was calculated for each patient based on administrative data. Patients operated on within 24h of the trauma were compared with patients operated on later than 24h after the trauma. The effects of surgical timing on complication rate and cost of hospitalization were adjusted for potential confounding variables using multiple regression analyses. Fifty-five patients were operated on 24h from injury and 142 were operated on >24h from injury. Baseline demographic and clinical variables were comparable between the two groups. Pneumonia, UTI, and the presence of any complications were significantly higher in the group operated on >24h post-trauma. Cost of hospitalization was higher among patients operated >24h post-trauma (24h: 22,828$ vs. >24h: 29,714$). Surgical timing >24h was a predictor of pneumonia, UTI, total complications. and higher cost of hospitalization after controlling for other confounding variables. This study shows that surgical decompression and stabilization 24h following a complete SCI may be a cost-effective strategy to reduce the postoperative complication rate.