The effect of operative timing on functional outcome after isolated spinal trauma.
BACKGROUND
To evaluate the effect of operative timing on functional outcome in patients suffering spinal trauma, we conducted a retrospective analysis of the National Trauma Data Bank. By treating time to operation as a categorical variable and limiting our analysis to isolated spinal trauma, we hypothesized that time to operation would not be a predictor of functional outcome.


METHODS
The National Trauma Data Bank was queried for all patients with isolated spinal trauma who underwent spinal fixation or decompression. Functional outcomes at the time of hospital discharge were measured using Functional Independent Motor Locomotion Score. Generalized ordered logistic model was used to determine the effect of time until operation on functional outcomes. Gender, age, injury severity, the level of trauma center, and the presence of spinal cord injury were included as covariates.


RESULTS
Of the final sample of 1,848 patients (mean age 44.3 years), 78% were White and 71% male. Fifty-seven percent of patients had Injury Severity Score between 8 and 15, with the remainder having Injury Severity Score ≤8. Forty-five percent were treated at a Level I trauma center. Using generalized ordered logistic regression, time to operation was not a significant predictor of functional outcomes, whereas treatment at Level I trauma centers seemed to confer marginally better outcomes.


CONCLUSIONS
In patients with isolated spinal trauma, time until spinal operation does not seem to be an important predictor of functional outcome at the time of hospital discharge. Operative timing, at the discretion of the surgeon, needs to consider the risks and benefits associated with delayed versus emergent operation.
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA. GSacks@mednet.ucla.edu
Greg D
GD
Sacks
Jaykar R
JR
Panchmatia
Miguel
M
Marino
Caterina
C
Hill
Selwyn O
SO
Rogers
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013124:Spinal Injuries / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult