Early spine surgery is associated with better outcomes in patients with a thoracic spinal cord injury: national database retrospective analysis

Introduction We aim to determine whether early surgery (within 24 h of admission) is associated with better discharge disposition in patients with isolated and polytraumatic thoracic SCI. Methods Patients in the Trauma Quality and Improvement Database from 2017 to 2023 presenting with a thoracic SCI and underwent surgical intervention were collected based on Abbreviated Injury Scale (AIS) codes and ICD-10 procedural codes. Polytrauma was determined as those patients presenting with an AIS ≥ 3 in a body region not associated with thoracic SCI and GCS < 14. Propensity score matching (PSM) was conducted to match early and late surgery groups for isolated SCI and polytrauma separately. Univariate analysis was conducted to determine differences in hospital complications and disposition. Multivariate logistic regression for disposition was modelled. Multivariate regression using the propensity matched data with a 3-level time to surgery variable (< 8 h, 8–24 h, 24 + hours) was modelled. Results After PSM there were 4,524 isolated and 2,842 polytrauma thoracic SCI patients. The isolated and polytrauma SCI group with early surgery had lower rates of hospital complications. Isolated SCI patients with late surgery had 22% (95% CI: 4%-42%) higher odds of poor disposition. Polytrauma patients with late surgery had 42% (95% CI: 18%-70%) higher odds of poor disposition. Isolated thoracic SCI patients undergoing surgery 8–24 h after admission had a 32% (95% CI: 4%-68%) increase in odds of poor disposition compared to those undergoing surgery within 8 h of admission. Conclusion Early surgery in patients presenting with an isolated thoracic SCI or polytrauma with thoracic SCI was associated with more positive discharge dispositions.