16. Discrepancies in the surgical management of central cord syndrome: assessment of nonoperative, surgical, and crossover to surgery patients

Abstract

BACKGROUND CONTEXT The efficacy of surgical intervention for central cord syndrome (CCS) is shown in the literature; however, it is unclear whether disparities in patient presentation and treatment exist between those who initially undergo operative treatment and those who delay operative treatment. PURPOSE In a population of CCS patients, assess disparities in presentation and treatment between those undergoing immediate surgery and those who delay operative treatment. STUDY DESIGN/SETTING Retrospective analysis of New York State Inpatient Database years 2004-2013. PATIENT SAMPLE A total of 1,301 CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18). OUTCOME MEASURES Time to surgery, length of stay (LOS). METHODS Patient-specific linkage codes allowed longitudinal tracking of inpatient stays within the study period. Demographics, comorbidities (Charlson Comorbidity Index [CCI]), complications, and surgical factors, including Mirza invasiveness score, were compared between CCS patients that initially underwent surgery (Initial) and patients that delayed operative treatment (Delayed) using Chi-squared tests and independent samples t-tests as appropriate. Similar tests assessed differences in demographics and comorbidity burden between nonoperative patients and surgical crossover patients. RESULTS Included: 1,301 CCS patients (62±16 yrs, 27% female). Follow-up rate was 67.3%; mean follow-up time was 515±707 days. By level of CCS injury, 61.0% of patients were injured between C1 and C4, 59.2% between C5-C7, 1.0% between T1-T6, and 0.6% between T7-T12. Overall, 800 (61%) patients underwent surgical treatment (procedural breakdown: 80% fusion, 59% decompression, including 38% discectomy and 23% other decompression of the spinal canal). Of the surgical patients, 621 (78%) had surgery at first recorded hospital visit, while 179 (22%) experienced a delay before surgical treatment. For patients that delayed treatment, mean time to surgery was 203±358 days. Initial and Delayed patients did not differ in sex (p=0.109) or CCI (p=0.894), though Initial patients were younger than Delayed (60±15 yrs vs 63±13, p=0.016) and had lower rates of diabetes and valvular disease (both p 0.05). Patients who delayed operative treatment did not differ from nonop patients in age (63±13 vs 63±17, p=0.802) or CCI (1.04±1.49 vs 1.06±1.49, p=0.923); however, Delayed patients had higher rates of diabetes (26% vs 18%, p=0.037), neurologic disorders (7% vs 1%, p CONCLUSIONS Although patients managed with initial surgical treatment of CCS had longer hospital stays and were treated with more invasive procedures, perioperative complications did not differ. Twenty-two percent of CCS patients crossed over from nonoperative to operative treatment, with a mean time to crossover of 203 days. Patients who crossed over to operative care were more comorbid than patients who remained nonoperative, indicating comorbidity burden may play a role in the decision to operate. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.