AB092. SOH24AB_159. Comparative outcomes of early vs. delayed surgical intervention in geriatric patients with spinal fractures and concomitant spinal cord injuries

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Background: The elderly population have high rates of morbidity and mortality following traumatic spinal cord injuries (SCIs) but are also at increased risk of intraoperative and postoperative complications. This makes treatment decision-making less clear and more challenging in this cohort compared to younger patients with similar injuries. Methods: A retrospective review was carried out at our centre from 2016–2020 to identify geriatric patients (≥65 years old) presenting with a traumatic SCI, managed surgically. Cohorts were categorised and compared for outcomes based on their time from injury to surgery. The different time intervals assessed include: 24 and 72 hours. Results: A total of 72 patients were identified. Thirteen/72 (18.1%) underwent surgery within 24 hours of their injury. Mean age of the entire cohort was 75.3 years, of which 47/72 (65%) were males. For the 24-hour time interval, there was a difference in intraoperative complications (4/13 vs. 7/59; P=0.043), postoperative complications (10/13 vs. 27/59; P=0.021), patients requiring high dependency unit (HDU) (8/13 vs. 14/59; P=0.004), patients requiring intensive care unit (ICU) (8/13 vs. 12/59; P=0.001) and overall mean length-of-stay (46.8 vs. 18.0; P=0.01). No difference existed for postoperative neurological improvement (3/13 vs. 27/59; P=0.067) or deterioration (2/13 vs. 7/59; P=0.363), revision surgeries (1/13 vs. 7/59; P=0.334) and 30-day mortality (0/13 vs. 6/59; P=0.115). Conclusions: This is the first study, to the authors best knowledge, that compares surgical outcomes in geriatric patients presenting with traumatic SCI depending on their injury to surgery time interval. Although limited by its retrospective design and sample size, this study highlights the potential benefit of delaying surgical intervention in this cohort.