238. Same-day surgical intervention dramatically minimizes complication occurrence and optimizes perioperative outcomes for central cord syndrome

Abstract

BACKGROUND CONTEXT As surgery is increasingly recommended for patients with neurologic deterioration secondary to central cord syndrome (CCS), it is important to investigate the relationship between time to surgery and patient outcomes. The merits of early vs delayed surgical treatment remain controversial in the literature. PURPOSE Investigate associations between time to surgical intervention and surgical outcomes for CCS patients STUDY DESIGN/SETTING Retrospective review of Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) PATIENT SAMPLE A total of 9,246 weighted inpatient discharges. OUTCOME MEASURES Complication rates, discharge destination, length of hospital stay (LOS). METHODS CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18) were isolated in the NIS database 2005-2013. Operative patients were grouped by time to intervention: same day as admission, 1-day delay, 2-day, 3-day, 4-7 days, 8-14 days, and >14 days. As appropriate, analysis of variance and chi-squared tests compared demographics, Charlson Comorbidity Index (CCI) scores, surgical details, LOS, discharge status, periop complications and total charges across patient groups. Controlling for age, CCI and concurrent traumatic fractures, binary logistic regression assessed surgical timing associated with increased odds of perioperative complication, using same-day patients as a reference group (odds ratio [95% confidence interval]). RESULTS Included: 6,734 CSS patients (59±16yrs, 26%F, mean CCI: 1.2±1.6). Overall rate of surgical treatment was 64.1%, with rates of surgery increasing from 2005 (50.0%) to 2013 (73.0%, p 14 days. Timing groups did not differ in trauma status at admission (shock or hemorrhage, p=0.261); however, age differed between groups (min: 1 day [58±15 years], max: >14 days [63±13 years], p 14 days to surgery had increased odds of periop cardiac (7.0 [1.6-30.0]) and infection (6.1 [2.2-16.3]) complications. All timing groups beyond 3 days showed increased odds of VTE: 4-7 days (3.0 [1.6-5.5]), 8-14 days (3.0 [1.4-6.3]), 14+ days (5.6 [2.3-13.6]). Same-day surgery was also associated with lower total hospital charges than delayed surgery ($87,741 vs $118,815-$272,901, p CONCLUSIONS Patients undergoing surgery for CCS on the same day as admission showed significantly lower odds of complication, hospital charges, and higher rates of discharge to home than patients that experienced a delay to operation. In contrast, patients delayed >14 days to surgery were associated with inferior outcomes, including increased odds of cardiac complication and infection. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.