Early versus Delayed Surgery for Acute Traumatic Cervical/Thoracic Spinal Cord Injury in Beijing, China: The Results of a Prospective, Multicenter Nonrandomized Controlled Trial

Orthopaedic Surgery, 2021 · DOI: 10.1111/os.13120 · Published: December 1, 2021

Simple Explanation

This study investigates whether early surgery (within 24 hours) for acute spinal cord injuries leads to better outcomes compared to delayed surgery in patients in Beijing, China. The researchers compared the improvement in neurological function, surgical details, ICU stay, hospital stay, and complications between the two groups. The study also examined the efficiency of the Chinese regional trauma treatment system in facilitating early surgical intervention for these patients.

Study Duration

3 years (June 2016 to June 2019)

Participants

148 patients with acute cervical/thoracic spinal cord injury

Evidence Level

Nonrandomized Controlled Trial

Key Findings

1
Patients who underwent early surgery had a significantly higher chance of at least a two-grade improvement on the American Spinal Injury Association Impairment Scale (AIS) compared to those with delayed surgery.
2
The early surgery group experienced longer surgical times, greater surgical bleeding, and a higher rate of admission to the ICU.
3
The Chinese regional trauma treatment system was more frequently utilized in the early surgery group, leading to reduced time in the transfer and inspection phases before surgery.

Research Summary

This study compared early versus delayed surgery for acute spinal cord injuries in Beijing, finding that early surgery may lead to better neurological recovery. Early surgery was associated with increased surgical time and bleeding but a higher likelihood of AIS grade improvement. The implementation of the Chinese regional trauma treatment system appears to expedite the surgical process for patients with acute SCI.

Practical Implications

Improved Neurological Outcomes

Early surgical decompression (within 24 hours) after spinal cord injury can lead to better neurological recovery compared to delayed surgery.

Optimized Trauma Systems

Efficient trauma treatment systems, like the Chinese regional model, can significantly reduce delays in diagnosis and treatment, facilitating timely surgical intervention.

Resource Allocation

Hospitals should consider the potential benefits of early surgery against the increased resource demands (longer surgical times, ICU admissions) to optimize patient care.

Study Limitations

1
Differences in study populations across the five hospitals may affect outcomes.
2
Significant differences in demographic and injury characteristics between the early and delayed surgery groups.
3
The study excluded medical expenses, limiting the economic analysis.

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