Comparing morbidity and mortality in adult patients with acute traumatic cervical spinal cord injury in 2013-2017 and 2018-2022: a retrospective 10-year national trend analysis.

OBJECTIVES

While considerable attention has been dedicated to quality improvement in spine surgery, few studies have evaluated progress in spinal cord injury (SCI) outcomes. This study aimed to assess whether morbidity and mortality trends have improved for acute cervical SCI patients in the last decade.

METHODS

The American College of Surgeons Trauma Quality Programs database was retrospectively queried and outcomes for adult patients with acute cervical SCI were compared between two 5-year groups: 2013-2017 and 2018-2022. Patient demographics, comorbidities, type of injury, treatment modality, and adverse events (AEs) were assessed. Multivariable logistic regression was used to identify independent predictors of AEs, non-routine discharge (NRD), and in-hospital mortality.

RESULTS

Compared to patients in the 2013-2017 cohort (n = 41,666), patients in the 2018-2022 cohort (n = 54,755) were significantly older on average (2013-2017: 54.0 ± 18.8 years, 2018-2022: 56.1 ± 18.5 years, p < 0.001) and had a significantly higher baseline comorbidity burden. Mean Injury Severity Score (ISS) was slightly higher in the 2018-2022 cohort than in the 2013-2017 cohort (2013-2017: 21.1 ± 15.3, 2018-2022: 21.3 ± 14.2, p < 0.001). Falls (2013-2017: 19.9 %, 2018-2022: 48.9 %, p < 0.001) were the most common mechanism of injury in the 2018-2022 cohort while "Other" injury was most common in the 2013-2017 cohort (2013-2017: 60.0 %, 2018-2022: 4.5 %, p < 0.001). Patients in the 2018-2022 had a higher frequency of any surgical procedure (2013-2017: 47.7, 2018-2022: 53.7, p < 0.001). The 2018-2022 cohort had a lower frequency of NRD (2013-2017: 75.3 %, 2018-2022: 74.2 %, p < 0.001) and unplanned reoperation (2013-2017: 0.9 %, 2018-2022: 0.5 %, p < 0.001), as well as shorter mean LOS (2013-2017: 12.2 ± 15.7 days, 2018-2022: 12.6 ± 16.2 days, p < 0.001) compared to the 2013-2017 patient cohort. Conversely, the 2018-2022 cohort had a significantly greater rate of in-hospital mortality (2013-2017: 11.3 %, 2018-2022: 12.6 %, p < 0.001) and unplanned ICU admission (2013-2017: 3.0 %, 2018-2022: 4.9 %, p < 0.001)than the 2013-2017 cohort. On multivariable analysis, undergoing treatment for SCI from 2018 to 2022 was significantly associated with decreased odds of NRD (aOR: 0.73, 95 % CI: 0.70-0.76), but increased odds of in-hospital mortality (aOR: 1.18, 95 % CI: 1.11-1.26).

CONCLUSION

Our study suggests patients undergoing treatment from 2018 to 2022 were at decreased risk of NRD, but increased risk of in-hospital mortality compared to patients undergoing treatment from 2013 to 2017.