Data presented at the annual meeting of the North America Spine Society (1–5 November 2011, Chicago, USA) indicate that the majority of patients with traumatic spinal cord injury have an adverse event in acute care. However, although these events are associated with an increased length of hospital stay, they do not appear to affect outcomes in the long-term.
Data presenter John Street, Department of Orthopaedics, Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia/Vancouver General Hospital, Canada, said: “We all know and appreciate that traumatic spinal cord injury are associated with adverse events and complications, but the actual rate of those complications and the implications for the length of stay and quality of life for the long term is unclear.”
He added that in his study, he and co authors identified patients with traumatic spinal cord injury, using the Rick Hansen Spinal Cord Injury Registry, who had been discharged from Vancouver General Hospital between 2008 and 2009. Of the 171 patients identified, 77.2% had at least one acute adverse event—significant more than the previously recorded figure at his institution of approximately 18%. Street said they found that a higher incidence in their study because they used a prospective system to identify adverse events rather than hospital records and ICD 9 codes. He added: “The literature on adverse events in spine surgery in general is inconsistent, all retrospective and poorly controlled”
The most frequent pre/post operative adverse events were urinary tract infections (32%), pneumonias (33%), neuropathic pain (15.2%), pressures sores (14.6%) and delirium (18.6%). Street said: “We looked at the factors that caused these adverse events. Age, injury, and motor score on admission were significantly associated with an occurrence of an adverse event. We found that there was an additional measurable risk for each adverse event per year increase in age and also per point decrease in total motor score on admission.” He explained that the importance of identifying the top five adverse events was that: “We can now use our data to identify the ‘patients at risk’ and so develop care pathways for prevention and/or early intervention.”
Importantly, each adverse event increased the length of hospital stay by more than twofold and having several adverse events further increased hospital stay. Street explained: “Patients who had three or more adverse events had a 2.6 increase in length of stay.” He added that the association between adverse events and hospital stay had implications for healthcare costs.
However, the study did not find a correlation between the occurrence of adverse events and long-term outcomes (using the SF36 health questionnaire). “So, why would adverse events in acute care not affect long-term outcomes? Acute medical interventions for these acute adverse events obviously significantly impact the effect that these adverse events have in the long-term. It is more likely that the consequences of the injury (e.g, spasticity, heterotopic ossification) or motor score on admission are reflected more in quality of life outcome scores in the long term.”