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  • The impact of transfers, delay in surgery and weekend operations on the outcomes of patients with cauda equina syndrome (CES): Analysis of Nationwide Inpatient Sample Database, years 2005-2009

    Final Number:

    Rishi Kumar Wadhwa MD; Jamie Toms; Ashish Sonig MD MCh neurosurgery; Bharat Guthikonda MD; Praveen V. Mummaneni MD; Anil Nanda MD FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Cauda equina syndrome (CES) is a severe neurological condition that is caused by the compression of the cauda equina(1). Symptoms of CES can include chronic back pain and sciatica progressing to weakness and loss of bowel and bladder function(1). There is a great amount of controversy regarding timing of surgical intervention (2). Some studies have suggested that all intervention should be done within 48 hours(1), while others suggest that time is not a critical factor in patient outcome(2). In this study we use the Nationwide Inpatient Sample Database to analyze outcome of patients with CES.

    Methods: The NIS database was studied for the patients with the diagnosis of cauda equina syndrome from years 2005-2009. Both surgical complications and non-surgical variables were analyzed. A discharge disposition coded as “routine” in the data set was taken as good discharge disposition. Chi-square and multivariate binary logistic regression models were used for analysis.

    Results: 1635 patients were analyzed with a mean age of 53.3 years. After logistical regression, the following variables were not significant for worse outcome: meningitis (p=0.99), wound infection (p=0.99), dural tear (p=0.015), nerve root injury (p=0.113), and paralytic ileus (p=0.99). However, UTI (p<0.01), being elderly (age over 65) (p<0.01), having been transferred from another facility (p<0.05), surgery later than 24 hours after being evaluated (p<0.05), and having surgery on the weekend (p<0.05) were all significant for a worse outcome.

    Conclusions: Worse outcomes in CES patients can be attributed to being over 65 and having a urinary tract infection and are strikingly associated with being transferred from another facility, surgery greater than 24 hours after index admission, and surgery on the weekend. We urge prompt evaluation and surgical intervention within the first 24 hours of diagnosis of cauda equina syndrome.

    Patient Care: by identifying risk factors for worse outcomes in patients with cauda equina syndrome

    Learning Objectives: We recommend using the format, "By the conclusion of this session, participants should be able to: 1) Describe the importance of cauda equina syndrome, 2) discuss in small groups the effect of transfer and delay in surgery and 3) identify an effective timely treatment of CES.

    References: 1. Daniels EW, Gordon Z, French K, Ahn UM, Ahn NU. Review of medicolegal cases for cauda equina syndrome: what factors lead to an adverse outcome for the provider? Orthopedics 34:e414-e419, 2012. 2. Todd NV. For debate—guidelines for the management of suspected cauda equina syndrome. British Journal of Neurosurgery 24:387-390, 2010.

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