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Predictors of In-Hospital Mortality After Operative Cervical Spinal Cord Injury: A National Trauma Data Bank Analysis
Mitchell K Ng1, Leonidas E Mastrokostas2,3, Paul G Mastrokostas3
1Thomas Jefferson University Hospital, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Global Spine Journal
|July 10, 2026
Summary
In-hospital mortality for operative cervical spinal cord injury (cSCI) is 7.1%, influenced by patient age, injury severity, and comorbidities. Factors like hypotension and neurological status significantly predict outcomes in these critical cases.
Area of Science:
- Trauma Surgery
- Neurosurgery
- Epidemiology
Background:
- Operative management of cervical spinal cord injury (cSCI) is complex.
- Predictors of in-hospital mortality in this population require further elucidation.
Purpose of the Study:
- To identify patient, injury, and hospital-level factors associated with in-hospital mortality following operative cSCI.
- To utilize a national trauma registry for comprehensive analysis.
Main Methods:
- Retrospective cohort study using the National Trauma Data Bank (NTDB) from 2021-2023.
- Inclusion of adult patients undergoing operative cervical spine treatment for cSCI.
- Multivariable logistic regression to determine independent predictors of mortality.
Main Results:
- A total of 18,401 patients were analyzed, with 7.1% experiencing in-hospital mortality.
- Mortality was independently associated with older age, higher Injury Severity Score (ISS), worse Glasgow Coma Scale (GCS), hypotension, critical spine AIS severity, and polytrauma.
- Comorbidities such as congestive heart failure, diabetes mellitus, and anticoagulant therapy were significant predictors.
Conclusions:
- In-hospital mortality after operative cSCI is substantial at 7.1%.
- Mortality is multifactorial, driven by initial physiological status, neurological deficit, injury severity, and patient comorbidities.
- These findings highlight critical areas for intervention and risk stratification.