title: Cervical Fracture Stabilization within 72 Hours of Injury is Associated with Decreased Hospitalization Costs with Comparable Perioperative Outcomes in a Propensity Score-Matched Cohort.
abstract: BACKGROUND
  Prior studies have indicated that early decompression of traumatic cervical fractures can be performed safely and is associated with improved outcomes, though the economic impact of the timing of surgery in the American population has not been studied. After adjusting for patient, hospital, and injury confounders, we performed propensity score modeling (PSM) on a large clinical administrative database to determine associated costs depending upon timing of surgery for acute cervical fracture.
  
  
  METHODS
  A total of 3,348 patients with surgically treated, traumatic, cervical fractures were identified. Patients were sorted into early (within 72 hours of admission) and late (beyond 72 hours) surgery groups. PSM was able to match 2,132 early and late surgery patients on age, comorbidity, expected payer, trauma severity, hospital type, urgent admission, and surgical approach. Perioperative complications, mortality, and resource utilization were assessed.
  
  
  RESULTS
  Late surgery was more frequently associated with increased age, more comorbidities, higher ICISS score, and non-private insurance. Following PSM matching, there were no significant, preoperative differences between early and late surgery groups. Surgery performed after 72 hours was associated with an increase in in-hospital complications (OR=1.3). The early surgery group was associated with decreased length of stay (11 days vs. 16 days, p <0.0001) and hospital charges ($237,786 v. $282,727, p <0.0001).
  
  
  CONCLUSIONS
  After controlling for potential confounding differences through PSM matching and multivariate analyses, we found late surgery independently associated with increased in-hospital complications, length of stay, and hospital resource utilization. These data suggest surgery within 72 hours may decrease resource utilization without a corresponding increase in postoperative morbidity.
authors.affiliation: Department of Neurosurgery, Stanford University.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Medress
authors.affiliation: School of Medicine, Stanford University.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arrigo
authors.affiliation: Department of Neurosurgery, Stanford University.
authors.forename: Melanie
authors.initials: M
authors.lastname: Hayden Gephart
authors.affiliation: Department of Neurosurgery, University of California, San Francisco.
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.affiliation: Department of Neurosurgery, University of Louisville.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
keywords: cervical fusion; health economics; propensity score modeling; spinal cord injury; spine trauma; surgical outcomes; timing of surgery