title: Is Urgent Decompression Superior to Delayed Surgery for Traumatic Spinal Cord Injury? A Meta-Analysis.
abstract: BACKGROUND
  Traumatic spinal cord injury (SCI) is a common disease in current clinical practice. Previous studies have reported that early surgical decompression was better to improve neurologic outcomes than that of late surgery. However, most of the studies set early surgery within 72 hours. Is urgent surgery within 24 hours superior to late surgery for SCI? It remains controversial.
  
  
  OBJECTIVE
  To determine whether neurologic outcomes of SCI in patients who underwent early surgery (<24 hours after injury) are better than those who underwent late surgery (≥ 24 hours after injury) by meta-analysis.
  
  
  METHODS
  Electronic databases such as PubMed, MEDLINE, EMBASE, and Cochrane library were selected to detect the potentially related trials up to June 2015 that compared the outcomes of early surgery (<24 hours after injury) versus late surgery (≥ 24 hours after injury) for the treatment of traumatic SCI. Data extraction and quality assessment were according to Cochrane Collaboration guidelines. Outcome evaluations were total motor score, neurologic improvement rate, length of hospital stay and intensive care unit (ICU) stay, complications, and mortality. Results were expressed as odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence interval (CI).
  
  
  RESULTS
  Nine articles comparing 2 cohorts that had early and late surgery for SCI were identified in this study. Statistically, there were significant differences between early and late surgery in total motor score (MD = 3.30, 95% CI = 0.82 ∼ 5.79, P < 0.01), neurologic improvement rate (OR = 1.66, 95% CI = 1.19 ∼ 2.31, P < 0.01), length of hospital stay (MD = -4.76, 95% CI = -9.19 ∼ -0.32, P = 0.04), and complications (OR = 0.61, 95% CI = 0.40 ∼ 0.91, P = 0.02). However, no significant differences were found between the 2 groups in mortality (OR = 1.39, 95% CI = 0.51 ∼ 3.75, P = 0.52). Two studies showed fewer ICU stays in the early-surgery group than in the late group.
  
  
  CONCLUSIONS
  On the basis of this meta-analysis, urgent surgery within 24 hours for SCI significantly improved the neurologic outcomes compared with late surgery. It is suggested that urgent decompression within 24 hours is superior to delayed surgery for SCI.
authors.affiliation: Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
authors.forename: Jia-Ming
authors.initials: JM
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Long
authors.affiliation: Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Peng
authors.affiliation: Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China. Electronic address: liuzhiliyfy@163.com.
authors.forename: Zhi-Li
authors.initials: ZL
authors.lastname: Liu
authors.affiliation: Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, P.R. China.
authors.forename: Shan-Hu
authors.initials: SH
authors.lastname: Huang
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods / Q000592:standards; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016017:Odds Ratio; D011597:Psychomotor Performance; D013119:Spinal Cord Injuries / Q000150:complications / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors
keywords: Decompression; Meta-analysis; Spinal cord injury; Urgent surgery