TY  - JOUR
PY  - 2021//
TI  - The reality of accomplishing surgery within 24 hours for complete cervical spinal cord injury: clinical practices and safety
JO  - Journal of neurotrauma
A1  - Balas, Michael
A1  - Prömmel, Peter
A1  - Nguyen, Laura
A1  - Jack, Andrew
A1  - Lebovic, Gerald
A1  - Badhiwala, Jetan H.
A1  - Da Costa, Leodante
A1  - Nathens, Avery B.
A1  - Fehlings, Michael G.
A1  - Wilson, Jefferson R.
A1  - Witiw, Christopher D.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - Substantial clinical data supports an association between superior neurological outcomes and early (within 24 hours) surgical decompression for those with traumatic cervical spinal cord injury (SCI). Despite this, much discussion persists around feasibility and safety of this time threshold, particularly for those with a complete cervical SCI. This study aims to assess clinical practices and the safety profile of early surgery across a large sample of North American trauma centers. Data was derived from the Trauma Quality Improvement Program database from 2010-2016. Adult patients with a complete cervical SCI (ASIA A) who underwent surgery were included. Patients were stratified into those receiving surgery at or before 24 hours and those receiving delayed intervention. Risk-adjusted variability in surgical timing across trauma centers was investigated using mixed-effects regression. In-hospital adverse events including mortality, major complications, and immobility-related complications were compared between groups after propensity score matching. 2,862 patients from 353 North American trauma centers were included. 1,760 (61.5%) underwent surgery within 24 hours. Case-mix and hospital-level characteristics explained only 6% of the variability in surgical timing both between-centers and within-centers. No significant differences in adverse events were identified between groups. These findings suggest a relatively large proportion of patients are not receiving surgery within the recommended timeframe, despite apparent safety. Moreover, patient and hospital-level characteristics explain little of the variability in time-to-surgery. Further knowledge translation is needed to increase the proportion of patients in whom surgery is performed before the 24-hour threshold so patients might reach their greatest potential for neurologic recovery.<p />  <p>Language: en</p>
LA  - en
SN  - 0897-7151
UR  - http://dx.doi.org/10.1089/neu.2021.0177
ID  - ref1
ER  -