title: Complications in acute phase hospitalization of traumatic spinal cord injury: does surgical timing matter?
abstract: BACKGROUND
  Optimal timing of surgery after a traumatic spinal cord injury (SCI) is one of the most controversial subjects in spine surgery. We assessed the relationship between surgical timing and the occurrence of nonneurologic postoperative complications during acute hospital stay for patients with a traumatic SCI.
  
  
  METHODS
  A retrospective cohort study was performed in a single institution. Four hundred thirty-one cases of traumatic SCI were reviewed, and postoperative complications were recorded from the medical charts. Patients were compared using two different surgical timing cutoffs (24 hours and 72 hours). Logistic regression analyses were modeled for complication occurrence. The effect of surgical timing on complication rate was adjusted for potential confounding variables such as the level of injury, American Spinal Injury Association (ASIA) grade, Injury Severity Score (ISS), age, sex, Charlson Comorbidity Index, and Surgical Invasiveness Index.
  
  
  RESULTS
  Patients operated on earlier were younger, had less comorbidity, had a higher ISS, and were more likely to have a cervical lesion and a complete injury (ASIA A). A reduction in the global rate of complications as well as in the rate of pneumonias and pressure ulcers were predicted by surgery performed earlier than 72 hours and 24 hours. Increasing age, more severe ASIA grade, and cervical lesion as well as increased Charlson Comorbidity Index, ISS, and SII were also statistically related to the occurrence of complications.
  
  
  CONCLUSIONS
  This study showed that a shorter surgical delay after a traumatic SCI decreases the rate of complications during the acute phase hospitalization. We suggest that patients with traumatic SCI should be promptly operated on earlier than 24 hours following the injury to reduce complications while optimizing neurologic recovery. If medical or practical reasons preclude timing less than 24 hours, efforts should still be made to perform surgery earlier than 72 hours following the SCI.
  
  
  METHODS
  Prognostic study, level III; therapeutic/care management study, level IV.
authors: Faculty of Medicine, University of Montreal, Montreal, Canada. etienne.bourassamoreau@gmail.com
authors: Étienne
authors: É
authors: Bourassa-Moreau
authors: Jean-Marc
authors: JM
authors: Mac-Thiong
authors: Debbie
authors: D
authors: Ehrmann Feldman
authors: Cynthia
authors: C
authors: Thompson
authors: Stefan
authors: S
authors: Parent
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome