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Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, Joaquim AF, Yurac R. In Reply to the Letter to the Editor Regarding “Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine”. World Neurosurg 2023; 172:121. [PMID: 37012723 DOI: 10.1016/j.wneu.2023.01.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile, Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Charles A Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, RS, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Kevin P White
- ScienceRight Research Consulting, London, Ontario, Canada
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, Santiago, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
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Cabrera JP, Carazzo CA, Guiroy A, White KP, Guasque J, Sfreddo E, Joaquim AF, Yurac R, Picard N, Donato M, Gorgas A, Peña E, González Ó, Mandiola S, Remondino R, Ortiz PN, Jiménez J, Gonzalez JDJ, Martinez O, Reyes P, Jara J, Burgos J, Gagliardi M, Ciancio AM, Uruchi D, Martínez R, Mireles N, Meira PH, Astur N, Meves R, Vieira R, Borges R, Chaves J, Guimaraes R, Balen M, Zamorano JJ, Zanini GR, Senna G, Cabrera PR, Ordoñez F, Vásquez FA, Daniel J, Veiga JC, Del Santoro P, Sebben AL, Orso V, Penteado R, Pino C, Velarde E, Jacob C, Dias W, Ujhelly JI, Estay A, Noleto G, de Sousa I, Amorim R, Carneiro M, Montoya F, Flórez D, Corrêa RA, Santiago B, Gonzalez AS. Risk Factors for Postoperative Complications After Surgical Treatment of Type B and C Injuries of the Thoracolumbar Spine. World Neurosurg 2023; 170:e520-e528. [PMID: 36402303 DOI: 10.1016/j.wneu.2022.11.059] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Unstable thoracolumbar spinal injuries benefit from surgical fixation. However, perioperative complications significantly affect outcomes in surgicallytreated spine patients. We evaluated associations between risk factors and postoperative complications in patients surgically treated for thoracolumbar spine fractures. METHODS We conducted a retrospective multicenter study collating data from 21 spine centers across 9 countries on the treatment of AOSpine types B and C injuries of the thoracolumbar spine treated via a posterior approach. Comparative analysis was performed between patients with postoperative complications and those without. Univariate and multivariable analyses were performed. RESULTS Among 535 patients, at least 1 complication occurred in 43%. The most common surgical complication was surgical-site infection (6.9%), while the most common medical complication was urinary tract infection (13.8%). Among 136 patients with American Spinal Injury Association (ASIA) Impairment Scalelevel A disability, 77.9% experienced at least 1 complication. The rate of complications also rose sharply among patients waiting >3 days for surgery (P<0.001), peaking at 68.4% among patients waiting ≥30 days. On multivariable analysis, significant predictors of complications were surgery at a governmental hospital (odds ratio = 3.38, 95% confidence interval = 1.73-6.60), having ≥1 comorbid illness (2.44, 1.61-3.70), surgery delayed due to health instability (2.56, 1.50-4.37), and ASIA Impairment Scalelevel A (3.36, 1.78-6.35), while absence of impairment (0.39, 0.22-0.71), ASIAlevel E (0.39, 0.22-0.67) and, unexpectedly, delay caused by operating room unavailability (0.60, 0.36-0.99) were protective. CONCLUSIONS Types B and C thoracolumbar spine injuries are associated with a high risk of postoperative complications, especially common at governmental hospitals, and among patients with comorbidity, health instability, longer delays to surgery, and worse preoperative neurologic status.
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Affiliation(s)
- Juan P Cabrera
- Department of Neurosurgery, Hospital Clínico Regional de Concepción, and Faculty of Medicine, University of Concepción, Concepción, Chile.
| | - Charles A Carazzo
- Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, RS, Brazil
| | - Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina
| | - Kevin P White
- Science Right Research Consulting, London, Ontario, Canada
| | | | - Ericson Sfreddo
- Department of Neurosurgery, Hospital Cristo Redentor, Porto Alegre, Brazil
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas-SP, Brazil
| | - Ratko Yurac
- Department of Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago, Chile
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Guiroy A, Carazzo CA, Zamorano JJ, Cabrera JP, Joaquim AF, Guasque J, Sfredo E, White K, Yurac R, Falavigna A. Time to Surgery for Unstable Thoracolumbar Fractures in Latin America-A Multicentric Study. World Neurosurg 2021; 148:e488-e494. [PMID: 33444839 DOI: 10.1016/j.wneu.2021.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to identify delays for surgery to stabilize unstable thoracolumbar fractures and the main reasons for them across Latin America. METHODS We reviewed the charts of 547 patients with type B or C thoracolumbar fractures from 21 spine centers across 9 Latin American countries. Data were collected on demographics, mechanism of trauma, time between hospital arrival and surgery, type of hospital (public vs. private), fracture classification, spinal level of injury, neurologic status (American Spinal Injury Association impairment scale), number of levels instrumented, and reason for delay between hospital arrival and surgical treatment. RESULTS The sample included 403 men (73.6%) and 144 women (26.3%), with a mean age of 40.6 years. The main mechanism of trauma was falls (44.4%), followed by car accidents (24.5%). The most frequent pattern of injury was B2 injuries (46.6%), and the most affected level was T12-L1 (42.2%). Neurologic status at admission was 60.5% intact and 22.9% American Spinal Injury Association impairment scale A. The time from admission to surgery was >72 hours in over half the patients and over a week in >25% of them. The most commonly reported reasons for surgical delay were clinical instability (22.9%), lack of operating room availability (22.7%), and lack of hardware for spinal instrumentation (e.g., screws/rods) (18.8%). CONCLUSIONS Timing for surgery in this sample of unstable fractures was over 72 hours in more than half of the sample and longer than a week in about a quarter. The main reasons for this delay were clinical instability and lack of economic resources. There is an apparent need for increased funding for the treatment of spinal trauma patients in Latin America.
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Affiliation(s)
- Alfredo Guiroy
- Spine Unit, Orthopedic Department, Hospital Español de Mendoza, Mendoza, Argentina.
| | - Charles A Carazzo
- Department of Neurosurgery, University of Passo Fundo, São Vicente de Paulo Hospital, Passo Fundo, Rio Grande do Sul
| | - Juan J Zamorano
- Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago
| | - Juan P Cabrera
- Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile
| | - Andrei F Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | - Kevin White
- ScienceRight Research Consulting, Ontario, Canada
| | - Ratko Yurac
- Orthopedic and Traumatology, University del Desarrollo, and Spine Unit, Department of Traumatology, Clínica Alemana, Santiago
| | - Asdrubal Falavigna
- Neurosurgery Department, University of Caxias do Sul, Caxias do Sul, Brazil
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