Perioperative complications in spinal trauma patients: does timing matter?

Background

Early surgery in traumatic spinal fracture treatment may facilitate prompt mobilization, encountering affiliated complications. However, the safety and the benefits of early surgery are being questioned in spinal trauma patients. Therefore, the objective of this retrospective study is to investigate the effect of surgical timing on perioperative complications in these patients.

Methods

Spinal trauma patients who underwent surgery between 2010 and 2020 in two Dutch Level-I trauma centers were included retrospectively and divided into an early (< 24 h), late (between 24 and 72 h) and delayed (> 72 h) surgical cohort. The primary outcome was the occurrence of peri-operative complications. Besides surgical timing, trauma and patient-specific factors were also analyzed as potential risk factors for the occurrence of complications.

Results

A total of 394 patients were included, of whom 149 received early, 159 late and 86 delayed surgical treatment. The occurrence of perioperative complications was significantly associated with age, body mass index, comorbidities, ASA grade 3 and 4, spinal cord injury (SCI), AO Spine type C injury, additional chest injury, and surgical delay. A multivariable analysis showed that age, ASA category, AO Spine classification and SCI were significantly associated with perioperative complications. Moreover, a subsequent analysis in non-SCI patients demonstrated an association between perioperative complications and delayed surgery.

Conclusions

In this study, delayed surgical treatment is potentially associated with more perioperative complications compared to early surgery in non-SCI patients. Other possible risk factors for the occurrence of perioperative complications may be older age, ASA 3 and 4, AO spine C injury and SCI.