|
Todd W Vitaz, MD
Christopher B Shields, MD
George H Raque, MD (Louisville, KY)
Introduction:
The appropriate timing for surgical
intervention following SCI has been a subject of intense debate.
Most studies have evaluated the effects of surgery on neurologic
outcome with little attention to other outcome parameters.
Method:
We reviewed our prospective SCI
database for patients who underwent surgical treatment for their
injuries. All patients were treated between August 1996 and October
1998 at the University of Louisville Hospital, Louisville, KY
and were managed in conjunction with our SCI clinical pathway.
Patients were separated into two groups based on the timing of
their surigcal intervention (treatment prior to or after PID
5).
Results:
Twenty–one of the 33 patients
treated with our SCI clinical pathway were treated surgically;
12 early (avg. PID 2.3), 9 late (avg. PID 8.4). Patients treated
in the early group had significantly shorter overall hospital
lengths of stay, ICU length of stay and number of ventilator
days (early: 17.4, 10.6, 5.7 days; late: 30.3, 26.9, 15.7 days
respectively; p less than 0.005); as well as fewer episodes of
pneumonia (early 0.6; late 1.6 episodes/patient; p=0.03). There
was no mortality in either group and only one complication directly
related to the surgical intervention, 4.5% (strut graft collapse).
Conclusion:
We believe that surgical intervention,
when necessary, in the form of spinal column stabilization should
be performed as soon as the patient is medically stable. We have
shown that such early intervention not only expedites patient
discharge with shorter lengths of stay; but also decreases the
rate of infectious complications.
|
