title: Morbidity of early spine surgery in the multiply injured patient.
abstract: BACKGROUND
  The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients.
  
  
  METHODS
  Patients were retrospectively categorized as stable or borderline unstable depending on the presence of at least one of the following: ISS >40, ISS >20 and chest injury, exploratory laparotomy or thoracotomy, lactate >2.5 mEq/L, platelet <110,000/mm(3), or >10 U PRBCs transfused pre-operatively. Surgical morbidity, complications, and neurologic improvement between the two groups were compared retrospectively.
  
  
  RESULTS
  30 casualties underwent 31 spine surgeries during a 12-month period. 16 of 30 patients met criteria indicating a borderline unstable patient. Although there were no significant differences in the procedures performed for stable and borderline unstable patients as measured by the Surgical Invasiveness Index (7.5 vs. 6.9, p = 0.8), borderline unstable patients had significantly higher operative time (4.3 vs. 3.0 h, p = 0.01), blood loss (1,372 vs. 366 mL, p = 0.001), PRBCs transfused intra-op (3.88 vs. 0.14 U, p < 0.001), and total PRBCs transfused in theater (10.18 vs. 0.31 U, p < 0.001).
  
  
  CONCLUSIONS
  The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.
authors: Orthopaedic Surgery Service, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, Washington, 98431, USA.
authors: J W
authors: JW
authors: Galvin
authors: B A
authors: BA
authors: Freedman
authors: A J
authors: AJ
authors: Schoenfeld
authors: A P
authors: AP
authors: Cap
authors: J M
authors: JM
authors: Mok
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009104:Multiple Trauma / Q000601:surgery*; D061646:Operative Time; D058996:Quality Improvement; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000601:surgery*; D013124:Spinal Injuries / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States