Surgical management of patients following traumatic spinal cord injury: Identifying barriers to early surgery in a specialized spinal cord injury center

Context/Objective: Early surgery in individuals with traumatic spinal cord injury (T-SCI) can improve neurological recovery and reduce complications, costs and hospitalization. Patient-related and healthcare- related factors could influence surgical delay. This study aimed at determining factors contributing to surgical delay in individuals with T-SCI. Design: Prospective cohort study. Setting: Single Level I trauma center in Quebec, Canada. Participants: One hundred and forty-four patients who sustained a T-SCI. Interventions: None. Outcome measures: Socio-demographic and clinical administrative data were collected during the pre-operative period. The cohort was stratified in early surgery, or ES (< 24 hours post-trauma) and late surgery, or LS (>= 24 hours post-trauma) groups. A multivariate logistic regression analysis using patient- and healthcare-related factors was carried out to identify the main predictors of LS. Results: 93 patients had ES (15.6 +/- 4.7 hours post-trauma), which is 31 hours earlier than the 51 patients in the LS group (46.9 +/- 30.9 hours; P < 10(-3)). The transfer delay from trauma site to the SCI center was 8 hours shorter (5.0 +/- 3.0 hours vs 13.6 +/- 17.0; P < 10(-3)) for the ES group, and the surgical plan was completed 17 hours faster (6.0 +/- 4.0 hours vs 23.3 +/- 23.6 hours; P < 10(-3)) than for the LS group. The occurrence of LS was predicted by modifiable factors, such as the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room. Conclusions: A dedicated team for surgical treatment of individuals with T-SCI, involving direct transfer to the SCI center, faster surgery planning and access to the operating room in hospitals dealing with emergencies from all subspecialties could improve surgical delay and increase the rate of patients undergoing ES.