Regional and Institutional Practice Variations in Decompressive Spine Surgery for Patients with Penetrating Spinal Injury in the United States

Abstract

The surgical management of penetrating spinal injury (PSI) has been widely debated in the literature, and the benefit of decompressive surgery for neurological function remains controversial. No national guidelines exist for the PSI population, and surgical practice patterns are unknown. We studied regional and institutional trends in the surgical management of PSI in the United States from 1988 to2011. The National Inpatient Sample database was accessed to identify a 20% stratified sample of PSI admissions to US hospitals from 1988 to 2011. PSI patients were divided into surgical (SXPSI) and nonsurgical (NSXPSI) groups, and these groups were analyzed across several regional, institutional, and patient-related variables. A total of 6632 PSI admissions were identified between 1988 and 2011. Decreased age (P= 0.002) and male gender (P= 0.015) were significantly more common in SXPSI than NSXPSI. Surgical rates were higher in teaching hospitals (P < 0.001), large hospitals (P= 0.012), and non-Northeast region hospitals (P < 0.020). Surgical management was associated with decreased mortality, increased length of stay, and increased total hospital charges (P < 0.001). Decompressive surgery rates for PSI differ significantly across regions and institutions in the United States. Institutional bias, patient preferences, and regional practice patterns all influence decision-making in PSI. A lack of large outcome studies in PSI and the absence of national guidelines contribute to variation in practice patterns. Our study indicates the need for future studies to better describe outcomes in patients with PSI.