Trends in Operative Timing for Acute Traumatic Central Cord Syndrome: National Inpatient Sample Analysis 2013-2019

Retrospective cohort study.

To analyze national trends in the management of acute traumatic central cord syndrome.

Acute traumatic central cord syndrome (ATCCS) is the most common incomplete spinal cord injury. Initial management involves decompression and stabilization of the cervical spinal cord. On the basis of mixed literature regarding operative timing for ATCCS, we aimed to evaluate trends in early, late, and delayed surgery over the last 5-10 years and compare their respective outcomes.

Data were obtained from the National Inpatient Sample (NIS) using specific ICD-10 codes. Baseline demographics, comorbidities, and outcomes were evaluated. These patients were grouped based on whether central cord syndrome (CCS) operative treatment was early (within 24h of admission), late (between 24 and 48h of admission), or delayed (after 48h of admission).

A total of 21,265 patients underwent operative management for ATCCS; 16.7% received early operative management, 35.6% received late operative management, and 47.6% received delayed operative management. Compared with the total cohort, the delayed operative management group was more likely to contain patients with obesity (7.1% vs. 6.3%, P <0.001), chronic obstructive pulmonary disease (COPD) (12.9% vs. 11.1%, P <0.001), and diabetes mellitus (28.1% vs. 26.1%, P <0.001). Early operative management was more likely in patients with plegia (24.7% vs. 17%, P <0.001) and bowel/bladder dysfunction (14.6% vs. 9.5%, P <0.001) and was independently associated with lower rates of prolonged length of stay (LOS) (OR=0.71) and acute kidney injury (AKI) (OR=0.696).

Our analysis of the trends in operative timing for ATCCS demonstrated an overall increase in the rate of early operative management and a decrease in the rate of delayed operative management. These findings mirror the current evolution of the literature on the topic. Nuances in early versus late outcomes should be used to help decision making related to operative timing in ATCCS.

Level III.