Temporal trends in major in-hospital and immobility-related complications following traumatic spinal cord injury: a retrospective cohort study

Abstract

Background: Traumatic spinal cord injury (SCI) is a catastrophic condition associated with significant morbidity and healthcare utilization. While existing literature has largely focused on long-term sequelae, data on temporal trends in early in-hospital and immobility-related complications are limited. This study aims to evaluate temporal trends in major in-hospital and immobility-related adverse events among patients with acute traumatic SCI. Methods: We conducted a retrospective cohort study using data from the American College of Surgeons Trauma Quality Improvement Program (TQIP) from 2017 to 2022. Patients aged 16 years and older with cervical, thoracic, or lumbar SCI were included. The primary outcome was major adverse events (MAEs), including cardiac arrest, stroke, unplanned intensive care unit (ICU) admission, intubation, and immobility-associated events (IAEs) such as surgical site infection, venous thromboemblism (VTE), pressure ulcers, catheter-associated urinary tract infections (CAUTI). The primary exposure was calendar year of hospital admission. Multivariable logistic regression models assessed associations between calendar year and complications. Subgroup analyses stratified by spinal level and by patients undergoing surgery. Results: A total of 78,571 patients met the inclusion criteria (mean age: 51.8 years; 75% male). Over the study period, patient age and comorbidity burden increased. The adjusted odds of several MAE increased, including cardiac arrest [odds ratio (OR) 1.05, per year after 2017, 95% confidence interval (CI): 1.02–1.09], stroke (OR 1.08, per year after 2017, 95% CI: 1.02–1.15), unplanned ICU admission (OR 1.07, per year after 2017, 95% CI: 1.04–1.09), intubation (OR 1.04, per year after 2017, 95% CI: 1.01–1.06), and unplanned return to the operating room (OR 1.21, per year after 2017, 95% CI: 1.17–1.26). Among IAE, the odds of deep vein thrombosis (DVT), pulmonary embolism, and pressure ulcers rose, while CAUTI rates declined (OR 0.89, per year after 2017, 95% CI: 0.85–0.93). Subgroup analyses by injury level and among surgically treated patients demonstrated similar temporal patterns. In multivariable models, higher odds of both MAE and IAE were independently associated with increasing year of admission, older age, greater comorbidity burden, complete SCI, fractures, penetrating trauma and lower presenting Glasgow Coma Scale (GCS). Conclusions: In this contemporary cohort of patients with traumatic SCI, the incidence of several MAE and IAE increased over time. These findings suggest a need for heightened vigilance, enhanced perioperative care, and the development of standardized prevention protocols targeting high-risk populations.