P134. Higher rates of medical complications and costs of care following delayed surgical intervention for cauda equina syndrome: a matched-control analysis

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BACKGROUND CONTEXT Studies have stressed the importance of timely surgical intervention for patients with cauda equina syndrome (CES); however, studies investigating outcomes between acute (within 48-hours) and delayed (after 48 hours) surgical intervention following CES while controlling for multiple confounders are limited. PURPOSE The purpose of this study was to determine whether delayed intervention has worse outcomes compared to acute intervention. Specifically, we investigated: (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) readmission rates; and 4) costs of care. STUDY DESIGN/SETTING Retrospective review of 100% Medicare claims database from 2005 to 2014. PATIENT SAMPLE The query yielded 17,177 patients undergoing surgical decompression for CES within (n = 14,310) or after (n = 2,867) 48 hours. OUTCOME MEASURES Primary outcomes analyzed included in-hospital LOS, 90-day medical complications, 90-day readmission rates, and 90-day costs of care. METHODS Patients with CES undergoing surgical decompression were identified and matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. Logistics regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch's t-tests were used to test for significance in LOS and costs of care between the cohorts. A p-value less than 0.01 was considered statistically significant. RESULTS The study demonstrated the delayed cohort had significantly longer in-hospital LOS (10-days vs 9-days, p=0.758), but failed to reach statistical significance. The delayed cohort had significantly higher incidence and odds of 90-day medical complications (85.3 vs 62.9%; OR: 3.43, 95%CI: 3.08 – 3.83, p CONCLUSIONS After matching for age, sex, and medical comorbidities, our study of over 17,000 patients demonstrated patients with delayed surgical intervention for CES have longer in-hospital LOS and higher rates of medical complications and costs of care. The study can be utilized by orthopedic surgeons to educate the importance of immediate surgical intervention in patients with CES. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.