Does optimal timing for spine fracture fixation exist?

Objective To evaluate the effect of timing of spine fracture fixation on outcome in m ultiply injured patients. Summary Background Data There is little consensus regarding the optimal timing of spine fracture fi xation after blunt trauma. Potential advantages of early fixation include e arlier patient mobilization and fewer septic complications; disadvantages i nclude compounded complications from associated injuries and inconvenience of surgical scheduling. Methods Patients with spine fractures from blunt trauma admitted to an urban level 1 trauma center during a 42-month period who required surgical spine fractu re fixation were identified from the registry. Patients were analyzed accor ding to timing of fixation, level of spine injury, and impact of associated injuries (measured by injury severity score). Early fixation was defined a s within 3 days of injury, and late fixation was after 3 days. Outcomes ana lyzed were intensive care unit and hospital stay, ventilator days, pneumoni a, survival, and hospital charges. Results Two hundred ninety-one patients had spine fracture fixation, 142 (49%) earl y and 149 (51%) late. Patients were clinically similar relative to age, adm ission blood pressure, injury severity score, and chest abbreviated injury scale score. The intensive care unit stay was shorter for patients with ear ly fixation. The incidence of pneumonia was lower for patients with early f ixation. Charges were lower for patients with early fixation. Patients were stratified by level of spine injury. There were 163 cervical (83 early, 80 late), 79 thoracic (30 early, 49 late), and 49 lumbar fractures (29 early, 20 late). There were no differences in injury severity between early and l ate groups for each fracture site. The most striking differences occurred i n the thoracic fracture group. Early fixation was associated with a lower i ncidence of pneumonia, a shorter intensive care unit stay, fewer ventilator days, and lower charges. High-risk patients had lower pneumonia rates and less hospital resource utilization with early fixation. Conclusions Early spine fracture fixation is safely performed in multiply i njured patients. Early fixation is preferred in patients with thoracic spin e fractures because it allows earlier mobilization and reduces the incidenc e of pneumonia. Although delaying fixation in the less severely injured may be convenient for scheduling, it increases hospital resource utilization a nd patient complications.