Outcomes and Translational Research, Center for Advanced Neurosurgery, University of Louisville, 220 Abraham Flexner Way, Louisville, KY 40202, USA.
J Neurotrauma. 2012 Aug 10;29(12):2220-5. doi: 10.1089/neu.2012.2364. Epub 2012 Jul 24.
The timing of surgery in patients with traumatic thoracic/thoracolumbar fractures, with or without spinal cord injury, remains controversial. The objective of this study was to determine the importance of the timing of surgery for complications and resource utilization following fixation of traumatic thoracic/thoracolumbar fractures. In this retrospective cohort study, the 2003-2008 California Inpatient Databases were searched for patients receiving traumatic thoracic/thoracolumbar fracture fixation. Patients were classified as having early (<72 h) or late (>72 h) surgery. Propensity score modeling produced a matched cohort balanced on age, comorbidity, trauma severity, and other factors. Complications, mortality, length of stay, and hospital charges were assessed. Multivariate logistic regression was used to determine the impact of delayed surgery on in-hospital complications after balancing and controlling for other important factors. Early surgery (<72 h) for traumatic thoracic/thoracolumbar fractures was associated with a significantly lower overall complication rate (including cardiac, thromboembolic, and respiratory complications), and decreased hospital stay. In-hospital charges were significantly lower ($38,120 difference) in the early surgery group. Multivariate analysis identified time to surgery as the strongest predictor of in-hospital complications, although age, medical comorbidities, and injury severity score were also independently associated with increased complications. We reinforce the beneficial impact of early spinal surgery (prior to 72 h) in traumatic thoracic/thoracolumbar fractures to reduce in-hospital complications, hospital stay, and resource utilization. These results provide further support to the emerging literature and professional consensus regarding the importance of early thoracic/thoracolumbar spine stabilization of traumatic fractures to improve patient outcomes and limit hospitalization costs.
对于合并或不合并脊髓损伤的创伤性胸腰椎骨折患者，手术时机仍存在争议。本研究旨在确定创伤性胸腰椎骨折固定术后并发症和资源利用的手术时机的重要性。在这项回顾性队列研究中，检索了 2003-2008 年加利福尼亚住院患者数据库，以寻找接受创伤性胸腰椎骨折固定的患者。患者分为早期（<72h）或晚期（>72h）手术。采用倾向评分匹配法对年龄、合并症、创伤严重程度等因素进行了匹配。评估了并发症、死亡率、住院时间和住院费用。采用多变量逻辑回归在平衡和控制其他重要因素后，确定延迟手术对住院并发症的影响。创伤性胸腰椎骨折的早期手术（<72h）与总体并发症发生率（包括心脏、血栓栓塞和呼吸系统并发症）显著降低以及住院时间缩短显著相关。早期手术组的住院费用显著降低（相差 38120 美元）。多变量分析确定手术时间是住院并发症的最强预测因素，尽管年龄、合并症和损伤严重程度评分也是并发症增加的独立相关因素。我们强调早期脊柱手术（<72h）对创伤性胸腰椎骨折的有益影响，可降低住院期间的并发症、住院时间和资源利用。这些结果为早期胸腰椎脊柱稳定创伤性骨折以改善患者结局和限制住院费用的重要性提供了进一步支持，这与新兴文献和专业共识一致。
