Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries

Abstract There are limited data pertaining to current practices in timing of surgical decompression for acute thoracolumbar spinal cord injury (SCI). We conducted a retrospective cohort study to evaluate variability in timing between- and within-trauma centers in North America; and to identify patie...

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Autores principales:	Jetan H. Badhiwala, Gerald Lebovic, Michael Balas, Leodante da Costa, Avery B. Nathens, Michael G. Fehlings, Jefferson R. Wilson, Christopher D. Witiw
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6fad7738cd7647558e7c5c83c9a52b9a
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spelling	oai:doaj.org-article:6fad7738cd7647558e7c5c83c9a52b9a2021-12-02T18:02:44ZVariability in time to surgery for patients with acute thoracolumbar spinal cord injuries10.1038/s41598-021-92310-z2045-2322https://doaj.org/article/6fad7738cd7647558e7c5c83c9a52b9a2021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-92310-zhttps://doaj.org/toc/2045-2322Abstract There are limited data pertaining to current practices in timing of surgical decompression for acute thoracolumbar spinal cord injury (SCI). We conducted a retrospective cohort study to evaluate variability in timing between- and within-trauma centers in North America; and to identify patient- and hospital-level factors associated with treatment delay. Adults with acute thoracolumbar SCI who underwent decompressive surgery within five days of injury at participating trauma centers in the American College of Surgeons Trauma Quality Improvement Program were included. Mixed-effects regression with a random intercept for trauma center was used to model the outcome of time to surgical decompression and assess risk-adjusted variability in surgery timeliness across centers. 3,948 patients admitted to 214 TQIP centers were eligible. 28 centers were outliers, with a significantly shorter or longer time to surgery than average. Case-mix and hospital characteristics explained < 1% of between-hospital variability in surgical timing. Moreover, only 7% of surgical timing variability within-centers was explained by case-mix characteristics. The adjusted intraclass correlation coefficient of 12% suggested poor correlation of surgical timing for patients with similar characteristics treated at the same center. These findings support the need for further research into the optimal timing of surgical intervention for thoracolumbar SCI.Jetan H. BadhiwalaGerald LebovicMichael BalasLeodante da CostaAvery B. NathensMichael G. FehlingsJefferson R. WilsonChristopher D. WitiwNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jetan H. Badhiwala Gerald Lebovic Michael Balas Leodante da Costa Avery B. Nathens Michael G. Fehlings Jefferson R. Wilson Christopher D. Witiw Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
description	Abstract There are limited data pertaining to current practices in timing of surgical decompression for acute thoracolumbar spinal cord injury (SCI). We conducted a retrospective cohort study to evaluate variability in timing between- and within-trauma centers in North America; and to identify patient- and hospital-level factors associated with treatment delay. Adults with acute thoracolumbar SCI who underwent decompressive surgery within five days of injury at participating trauma centers in the American College of Surgeons Trauma Quality Improvement Program were included. Mixed-effects regression with a random intercept for trauma center was used to model the outcome of time to surgical decompression and assess risk-adjusted variability in surgery timeliness across centers. 3,948 patients admitted to 214 TQIP centers were eligible. 28 centers were outliers, with a significantly shorter or longer time to surgery than average. Case-mix and hospital characteristics explained < 1% of between-hospital variability in surgical timing. Moreover, only 7% of surgical timing variability within-centers was explained by case-mix characteristics. The adjusted intraclass correlation coefficient of 12% suggested poor correlation of surgical timing for patients with similar characteristics treated at the same center. These findings support the need for further research into the optimal timing of surgical intervention for thoracolumbar SCI.
format	article
author	Jetan H. Badhiwala Gerald Lebovic Michael Balas Leodante da Costa Avery B. Nathens Michael G. Fehlings Jefferson R. Wilson Christopher D. Witiw
author_facet	Jetan H. Badhiwala Gerald Lebovic Michael Balas Leodante da Costa Avery B. Nathens Michael G. Fehlings Jefferson R. Wilson Christopher D. Witiw
author_sort	Jetan H. Badhiwala
title	Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
title_short	Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
title_full	Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
title_fullStr	Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
title_full_unstemmed	Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
title_sort	variability in time to surgery for patients with acute thoracolumbar spinal cord injuries
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/6fad7738cd7647558e7c5c83c9a52b9a
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Variability in time to surgery for patients with acute thoracolumbar spinal cord injuries

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