Early Surgical Decompression for Traumatic Cervical Spinal Cord Injury (SCI): A Process Benchmarking AppraisalJulio C. Furlan, MD, PhD1, Michael Fehlings, MD, PhD11Toronto, Canada Keywords: Decompression, cervical spine, spinal cord injury, spinal fusion, outcome
This study examines the process benchmarking of management of patients with acute SCI in order to determine the potential barriers and ideal timelines for each step to early surgical decompression.
We collected data from charts and the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS) forms regarding the time and reasons for delay of each step in the management of patients with SCI. The reasons for delays in the management steps will be classified into: (a) healthcare-related (extrinsic) factors and (b) patient-related (intrinsic) factors. The cases were grouped into patients who underwent early surgical decompression of spinal cord (Group-1) and individuals who underwent later surgery (<24 hours) (Group-2).
While both groups showed comparable time periods related to intrinsic factors, Group-1 had a significantly shorter time period associated with extrinsic factors when compared with Group-2 (19.16, 71.28hours). Both groups were comparable regarding prehospital time (137, 185.5min), time in a second general hospital prior to transfer to spine center (369.5, 730.8min) and time in the trauma emergency department (221.7, 226.4min). Group-1 had significantly shorter waiting time (577.6, 1982.1min), shorter waiting time for assessment by spine surgeon (73.5, 274.4min) and shorter waiting time for surgical decision (241.7, 832.3min).
This is a retrospective study.
Our benchmarking analysis suggests that health-related factors are key determinants of the timing from SCI to spinal cord decompression.
Time in the general hospital and time of waiting for surgical decision were the most important causes of delays for surgical spinal cord decompression. Early surgery is possible in the vast majority of the cases. Project Roles:
J. Furlan (), M. Fehlings ()