Incidence and Predictors of Systemic Complications in Hospitalized Patients With Cervical Traumatic Spinal Cord Injury

Background/Aim: Traumatic spinal cord injury (tSCI) is accompanied by systemic physiological vulnerability due to autonomic dysregulation and impaired organ function. Although acute systemic complications are common and may compromise early outcomes, their independent predictors remain unclear, particularly in Asian health-care settings, in which prolonged acute hospitalization is common. This study aimed to determine the incidence and independent predictors of systemic complications among surgically treated patients with cervical tSCI. Patients and Methods: This retrospective study included adults with acute cervical tSCI who underwent surgery at a single tertiary center between 2010 and 2025. Demographic characteristics, injury characteristics, clinical course variables, and in-hospital systemic complications were evaluated. Outcomes assessed included in-hospital mortality and neurological improvement, defined as an increase of ≥1 American Spinal Injury Association grade at discharge. Multivariable logistic regression was performed to identify independent predictors of major complications. Results: Data on 92 patients were analyzed. Urinary tract infection (UTI; 35.9%), pneumonia (22.8%), and ileus (18.5%) were the most frequent complications. In-hospital mortality rate was 8.7%. Approximately 41.3% of the patients exhibited neurological improvement. Initial American Spinal Injury Association grade was significantly associated with both neurological recovery and mortality. Pneumonia and UTI were strongly associated with in-hospital death. Longer hospital stay was independently associated with UTI and ileus, whereas advanced age and lower body mass index were independently associated with ileus. Longer ventilator exposure was independently associated with respiratory complications. Conclusion: Systemic complications are common after surgical treatment of cervical tSCI and are closely associated with early mortality. Care-related factors, particularly prolonged hospitalization and ventilator exposure, were associated with systemic complications. These variables may represent markers of a more complicated clinical course rather than direct causal factors and should be interpreted accordingly.