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

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2016.1165448 · Published: March 1, 2018

Spinal Cord InjuryHealthcareSurgery

Simple Explanation

This study investigates factors that delay surgery for individuals with traumatic spinal cord injuries (T-SCI). Early surgery can improve outcomes, but patient-related and healthcare-related factors can cause delays. The study aims to identify these factors in a specialized SCI center. The research involved collecting data on patients with T-SCI, dividing them into early and late surgery groups, and analyzing patient and healthcare factors. The goal was to find predictors of late surgery to improve the speed and efficiency of care. The findings suggest that delays in transferring patients to the SCI center, planning surgery, and accessing the operating room are major contributors to surgical delays. Addressing these modifiable factors could increase the rate of early surgeries.

Study Duration
April 2010 and May 2015
Participants
One hundred and forty-four patients who sustained a T-SCI
Evidence Level
Prospective cohort study

Key Findings

  • 1
    Transfer delays from the trauma site to the SCI center significantly contribute to surgical delays.
  • 2
    The time it takes to complete the surgical plan is a critical factor in determining whether a patient receives early or late surgery.
  • 3
    Delays in accessing the operating room after the surgical plan is completed also contribute to late surgeries.

Research Summary

The study aimed to determine factors contributing to surgical delay in individuals with T-SCI. It stratified patients into early surgery (ES) and late surgery (LS) groups and analyzed patient- and healthcare-related factors. The results showed that the transfer delay to the SCI center, the delay before surgical plan completion, and the waiting time for the operating room were predictors of late surgery. The conclusion suggests that a dedicated team, direct transfer to the SCI center, faster surgery planning, and better access to the operating room could improve surgical delay and increase early surgery rates.

Practical Implications

Optimize Transfer Protocols

Streamline the transfer process to the SCI center, potentially bypassing community hospitals for patients within a short distance of the specialized center.

Expedite Surgical Planning

Improve the efficiency of the surgical planning process, possibly through a dedicated trauma team and quicker access to specialized imaging.

Improve OR Access

Prioritize spine surgeries for T-SCI patients to reduce delays between surgical plan completion and the start of the surgery.

Study Limitations

  • 1
    The study was conducted at a single Level I trauma center in Québec, Canada.
  • 2
    A small percentage of patients were directly transported from the site of trauma to the SCI center.
  • 3
    Data collection was limited to the pre-operative period.

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