Comparing Morbidity and Mortality in Adult Patients with Acute Traumatic Cervical Spinal Cord Injury in 2013-2017 and 2018-2022

Introduction: Considerable attention has been dedicated to quality improvement in spine surgery, however few studies have evaluated progress in spinal cord injury (SCI) outcomes. This study aimed to assess whether morbidity and mortality has improved for patients recovering from acute cervical SCI in the last decade.

Methods: The American College of Surgeons Trauma Quality Programs (TQP) database was retrospectively queried and outcomes for adult patients with acute cervical SCI were compared between two 5-year groups: 2013-2017 and 2018-2022. Patient demographics, comorbidities, type of injury, treatment modality, adverse events (AEs) were assessed. Multivariate logistic regression was used to identify independent predictors of adverse events, non-routine discharge, and in-hospital mortality.

Results: Compared to patients in the 2013-2017 cohort (n=41,666), patients in the 2018-2022 cohort (n=54,755) were significantly older on average (2013-2017: 54.0 ± 18.8 years vs. 2018-2022: 56.1 ± 18.5 years, p< 0.001) and had a significantly higher baseline comorbidity burden. Falls were the most common mechanism of injury in the 2018-2022 cohort (2013-2017: 19.9% vs. 2018-2022: 48.9%, p< 0.001). Significantly fewer patients in the 2018-2022 cohort experienced any AE (2013-2017: 31.7% vs. 2018-2022: 20.4%, p< 0.001) and non-routine discharge (2013-2017: 75.3% vs. 2018-2022: 74.2%, p< 0.001) compared to the 2013-2017 patient cohort. Conversely, the 2018-2022 cohort had a significantly greater in-hospital mortality rate than the 2013-2017 cohort (2013-2017: 11.3% vs. 2018-2022: 12.6%, p< 0.001). On multivariate analysis, undergoing treatment for SCI from 2018-2022 was a significantly associated with decreased odds of AEs (OR: 0.80; CI: 0.75-0.86; p< 0.001) and non-routine discharge (OR: 0.85; CI: 0.79-0.91; p< 0.001), but increased odds of in-hospital mortality (OR: 1.11; CI: 1.04-1.19; p=0.003).

Conclusion : Our study suggests patients undergoing treatment from 2018-2022 were at decreased risk of AEs and non-routine discharge, but slightly increased risk of in-hospital mortality compared to patients undergoing treatment from 2013-2017.