• Khaled M Taghlabi, Jaime R Guerrero, Lokeshwar S Bhenderu, Jiaqiong Xu, Rijul Nanda, Isuru A Somawardana, Ahmed M A Baradeiya, Aboud Tahanis, Jesus G Cruz-Garza, Yevgeniy Freyvert, Todd W Trask, Meng Huang, Sean M Barber, Paul J Holman, and Amir H Faraji.
• Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, USA; Clinical Innovations Laboratory, Department of Neurological Surgery, Houston Methodist Research Institute, Houston, Texas, USA. Electronic address: ktaghlabi@houstonmethodist.org.
• World Neurosurg. 2024 Oct 1; 190: e637e647e637-e647.

ObjectiveSurgical intervention for unstable thoracolumbar spine fractures is common, but delayed management and complications can impact outcomes. This study compares perioperative outcomes between patients directly admitted and those transferred from another facility for thoracolumbar spine surgery, aiming to identify predictors of complications and mortality.MethodsA multicenter retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2021 identified 61,626 patients undergoing fusion surgeries for thoracolumbar spine fractures, excluding spinal cord injury or pathological fractures. Patients were categorized as Direct (admitted from the emergency department) and Transfer (transferred from another facility). Perioperative outcomes, including operative time, length of stay (LOS), 30-day mortality, and complications, were compared.ResultsOur patient population (54.3% female, mean age 62.4 ± 12.9 years) comprised 12.2% Transfer and 87.8% Direct patients. Following propensity score matching, Transfer patients had a longer hospital LOS (5.1 ± 5.7 days vs. 4.5 ± 4.6 days, P < 0.001). Transfer exhibited higher rates of superficial incisional surgical site infection (1.7% vs. 1.1%, P = 0.003), sepsis (1.7% vs. 1.3%, P = 0.038), pneumonia (1.7% vs. 1.2%, P = 0.019), postoperative reintubation (0.9% vs. 0.6%, P = 0.036), and failure to wean off ventilator >48 hours postsurgery (0.7% vs. 0.3%, P = 0.005) compared to Direct admissions. Direct group had a higher rate of perioperative transfusion (16.5% vs. 13.4%, P < 0.001). Transfer patients also had a higher 30-day mortality rate compared to Direct admissions (1.1% vs. 0.6%, P = 0.002).ConclusionsInterhospital transfers significantly affect hospital LOS, postoperative morbidity, and mortality in thoracolumbar spine surgery. Enhancing postoperative monitoring for transfer patients is crucial.Copyright © 2024 Elsevier Inc. All rights reserved.

29 keywords...

hide…