The following is a summary of “Surgery on the Day of Admission Decreases Postoperative Complication Rates for Patients With Central Cord Syndrome,” published in the June 2023 issue of Spinal Disorders and Techniques by Smith et al.
The design of the study was a retrospective analysis. This research aimed to ascertain the “early optimal timing” of central cord syndrome (CCS) surgical management to reduce medical complications. Data are inconsistent on the optimal time for surgical treatment of CCS, with some studies favoring early intervention and others arguing that surgery can or should be delayed by 2–6 weeks. This IRB-approved study was a retrospective cross-sectional analysis of surgical management outcomes for CCS patients using the National Surgical Quality Improvement Program database, which consists of anonymized medical record data from 2010 to 2020. Age, gender, American Society of Anesthesiologists score, current procedural terminology codes, duration of stay, and postoperative complications were recorded for each patient.
The patients were divided into three groups: admission-day surgery, next-day surgery, and late surgery. About 738 patients who underwent surgery to treat CCS between 2010 and 2020 were identified in the National Surgical Quality Improvement Program database and included in this study. After multivariate analysis, admission-day surgery was associated with a lower postoperative complication rate (odds ratio: 0.52; 95% CI: 0.28–0.97; P=0.0387) and shorter duration of stay (P<0.0001). Multivariate analysis revealed no difference in complication rates between the next-day surgery cohort and the late surgery cohort (odds ratio: 1.02; 95% CI: 0.63–1.65; P=0.9451), but the length of stay was shortened for next-day surgery (P< 0.0001).
The admission-day and next-day surgery rates have compound annual growth rates of 2.52% and 4.10%, respectively, over the past two years. In patients admitted for surgical treatment of CCS, admission-day surgery is associated with substantially lower 30-day complication rates and shorter lengths of stay. Therefore, researchers advocate that “early surgery” be defined as surgery performed on the day of admission and as promptly as feasible. Prior studies describing “early surgery” as occurring within 24 hours may have fallen short of the optimal threshold for reducing 30-day medical complications related to treating patients with CCS.