Introduction: Considerable controversy exists regarding the timing of surgery for acute cervical spine fractures. Previous studies have been mainly single-institution cases series, therefore, limited by the capabilities of individual centers and surgeons.
Methods: A total of 1,893 patients with surgically-treated cervical fractures with or without spinal cord injury were identified by ICD-9 code in the 2003 to 2008 California State Inpatient Database. Patients were sorted as having early surgery (within 72 hours) versus late surgery (beyond 72 hours). Propensity-score matching (PSM) was used to match early and late surgery patients on age, comorbidity, and trauma severity score. Perioperative outcomes, mortality and resource utilization were assessed. Multivariate logistic regression determined whether timing of surgery predicted perioperative complications after controlling for other factors. These data were repeated and confirmed with a 24 hour time point cut off for early surgery.
Results: 66% of patients were operated on within 72 hours of admission. Delayed surgery was associated with older age, increased comorbidities and trauma severity. After PSM, there were no significant known pre-operative differences among the 1,262 patients in the matched cohorts. No statistically significant differences were found between the early and delayed surgery group for in-hospital complication rate (24% vs. 27%), non-routine discharge status (51% vs. 55%), or mortality (3.3% vs. 2.5%). This was confirmed on multivariate analysis. Length of stay (10 days vs. 15 days) and hospital charges ($191,902 v. $227,425) were significantly less in the early surgery group (p <0.002). Repeating the above analysis using a cutoff time of 24 hours for early vs. delayed surgery resulted in the same results.
Conclusions: In a large administrative database study, timing of surgery following cervical fracture was not found to be a significant predictor of perioperative complications, discharge status, or mortality. Delayed surgery was associated with longer hospital stays and greater healthcare resource utilization.
Patient Care: Early surgery for cervical fractures is associated with equivalent outcomes, but decreased expenditures.
Learning Objectives: Early surgery for cervical fractures is associated with equivalent outcomes, but decreased expenditures.