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Ricciardi GA, Cabrera JP, Martínez O, Matta J, Vilchis H, Perez Ríos JJ, Carazzo CA, Dittmar M, Yurac R. Predicting early complications in patients with spinal gunshot wounds: A multicenter study. Brain Spine 2024; 4:102766. [PMID: 38510628 PMCID: PMC10951780 DOI: 10.1016/j.bas.2024.102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
Introduction There is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research question we aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methods This is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. Results Results: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68-7.30), dirty wound (3.32, 1.50-7.34), GCS ≤8 (3.56, 1.17-10.79), hemodynamic instability (2.29, 1.07-4.88), and multiple bullets (1.97, 1.05-3.67). Discussion and conclusion Spinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.
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Affiliation(s)
- Guillermo A. Ricciardi
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
| | - Juan P. Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
| | - Oscar Martínez
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
| | - Javier Matta
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
| | - Hugo Vilchis
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
| | - Jeasson Javier Perez Ríos
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
| | - Charles A. Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
| | - Michael Dittmar
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
| | - the AO Spine Latin America Trauma Study Group
- Orthopaedics and Traumatology, Centro Médico Integral Fitz Roy, Acevedo 865, C1414, Buenos Aires, Argentina
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, San Martín 1436, 4070022, Concepción, Bío Bío, Chile
- Faculty of Medicine, University of Concepción, Janequeo esquina, Av. Chacabuco S/N, Concepción, Bío Bío, Chile
- Hospital Universitario Dr. José E. González, Av. Dr. José Eleuterio González S/N, Mitras Centro, 64460, Monterrey, N.L., Mexico
- Hospital Militar Central, v. 3C No. 49 – 02, CP 110231, Bogotá, Colombia
- Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia, Lomas Verdes IMSS, Avenida Lomas Verdes 52, Sta Cruz Acatlan, 53150, Naucalpan de Juárez, Méx., Mexico
- Clínica de Columna “Dr. Manuel Dufoo Olvera”, Calz. San Juan de Aragón 285, Granjas Modernas, Gustavo A. Madero, 07460, Ciudad de México CDMX, Mexico
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, R. Teixeira Soares, 808 - Centro, Passo Fundo, RS, 99010-080, Brazil
- Centro Médico Puerta de Hierro, Av. Empresarios, Puerta de Hierro, 45116, Zapopan, Jal., Mexico
- Department of Orthopedic and Traumatology, Universidad del Desarrollo, Av Plaza 680, 7610658, Las Condes, Región Metropolitana, Chile
- Spine Unit, Department of Traumatology, Clínica Alemana, Av Vitacura 5951, Vitacura, Región Metropolitana, Santiago, Chile
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