title: Does timing of surgery affect hospitalization costs and length of stay for acute care following a traumatic spinal cord injury?
abstract: Although there is a trend toward performing early surgery for traumatic spinal cord injury (SCI), it remains unclear whether this tendency leads to decreased costs and length of stay (LOS) for acute care. This study determined the impact of surgical timing on costs and LOS after a traumatic SCI. A total of 477 consecutive patients sustaining an acute traumatic SCI and receiving surgery at a level I trauma center were included. A general linear model was used to assess the relationship among costs, LOS, and surgical delay, while accounting for various sociodemographic and clinical covariables. The analysis was also repeated with surgical delay dichotomized within 24 h or later after the trauma. Mean costs and LOS for all patients were respectively 24,156 ± 17,244 $CAD and 35.0 ± 39.4 days. The costs of acute care hospitalization were related to the surgical delay between the trauma and the surgery, in addition to age, injury severity score (ISS), American Spinal Injury Association (ASIA) grade, and neurological level. LOS was associated with the surgical delay dichotomized into two groups (<24 vs. ≥24 h), as well as with age, ISS, ASIA grade, and neurological level. This study suggests that resource utilization in terms of costs and LOS for the acute hospitalization is decreased with early surgery after an acute traumatic SCI, particularly if the procedure is performed within 24 h following the trauma. Performing the surgery as early as possible when the patient is cleared for surgery could lower the financial burden on the healthcare system, while optimizing the neurological recovery.
authors.affiliation: Faculty of Medicine, University of Montreal, Canada. macthiong@gmail.com
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Mac-Thiong
authors.forename: Debbie Ehrmann
authors.initials: DE
authors.lastname: Feldman
authors.forename: Cynthia
authors.initials: C
authors.lastname: Thompson
authors.forename: Etienne
authors.initials: E
authors.lastname: Bourassa-Moreau
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D003627:Data Interpretation, Statistical; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*; D013119:Spinal Cord Injuries / Q000191:economics* / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers