Morbidity of early spine surgery in the multiply injured patient

J. W. Galvin, Brett Freedman, A. J. Schoenfeld, A. P. Cap, J. M. Mok

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients. Materials and methods: Patients were retrospectively categorized as stable or borderline unstable depending on the presence of at least one of the following: ISS >40, ISS >20 and chest injury, exploratory laparotomy or thoracotomy, lactate >2.5 mEq/L, platelet <110,000/mm3, or >10 U PRBCs transfused pre-operatively. Surgical morbidity, complications, and neurologic improvement between the two groups were compared retrospectively. Results: 30 casualties underwent 31 spine surgeries during a 12-month period. 16 of 30 patients met criteria indicating a borderline unstable patient. Although there were no significant differences in the procedures performed for stable and borderline unstable patients as measured by the Surgical Invasiveness Index (7.5 vs. 6.9, p = 0.8), borderline unstable patients had significantly higher operative time (4.3 vs. 3.0 h, p = 0.01), blood loss (1,372 vs. 366 mL, p = 0.001), PRBCs transfused intra-op (3.88 vs. 0.14 U, p < 0.001), and total PRBCs transfused in theater (10.18 vs. 0.31 U, p < 0.001). Conclusions: The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.

Original languageEnglish (US)
Pages (from-to)1211-1217
Number of pages7
JournalArchives of Orthopaedic and Trauma Surgery
Volume134
Issue number9
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Spine
Morbidity
Wounds and Injuries
Afghanistan
Spinal Injuries
Thoracic Injuries
Thoracotomy
Operative Time
Laparotomy
Nervous System
Lactic Acid
Blood Platelets

Keywords

  • Afghanistan war
  • Combat spine trauma
  • Military casualties
  • Operation enduring freedom
  • Polytrauma
  • Spine fracture
  • Spine surgery in theater

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Morbidity of early spine surgery in the multiply injured patient. / Galvin, J. W.; Freedman, Brett; Schoenfeld, A. J.; Cap, A. P.; Mok, J. M.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 134, No. 9, 01.01.2014, p. 1211-1217.

Research output: Contribution to journalArticle

Galvin, J. W. ; Freedman, Brett ; Schoenfeld, A. J. ; Cap, A. P. ; Mok, J. M. / Morbidity of early spine surgery in the multiply injured patient. In: Archives of Orthopaedic and Trauma Surgery. 2014 ; Vol. 134, No. 9. pp. 1211-1217.
@article{136d764b714f438f88ee9505f093e128,
title = "Morbidity of early spine surgery in the multiply injured patient",
abstract = "Introduction: The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients. Materials and methods: Patients were retrospectively categorized as stable or borderline unstable depending on the presence of at least one of the following: ISS >40, ISS >20 and chest injury, exploratory laparotomy or thoracotomy, lactate >2.5 mEq/L, platelet <110,000/mm3, or >10 U PRBCs transfused pre-operatively. Surgical morbidity, complications, and neurologic improvement between the two groups were compared retrospectively. Results: 30 casualties underwent 31 spine surgeries during a 12-month period. 16 of 30 patients met criteria indicating a borderline unstable patient. Although there were no significant differences in the procedures performed for stable and borderline unstable patients as measured by the Surgical Invasiveness Index (7.5 vs. 6.9, p = 0.8), borderline unstable patients had significantly higher operative time (4.3 vs. 3.0 h, p = 0.01), blood loss (1,372 vs. 366 mL, p = 0.001), PRBCs transfused intra-op (3.88 vs. 0.14 U, p < 0.001), and total PRBCs transfused in theater (10.18 vs. 0.31 U, p < 0.001). Conclusions: The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.",
keywords = "Afghanistan war, Combat spine trauma, Military casualties, Operation enduring freedom, Polytrauma, Spine fracture, Spine surgery in theater",
author = "Galvin, {J. W.} and Brett Freedman and Schoenfeld, {A. J.} and Cap, {A. P.} and Mok, {J. M.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1007/s00402-014-2068-7",
language = "English (US)",
volume = "134",
pages = "1211--1217",
journal = "Archiv fur orthopadische und Unfall-Chirurgie",
issn = "0003-9330",
publisher = "Springer Verlag",
number = "9",

}

TY - JOUR

T1 - Morbidity of early spine surgery in the multiply injured patient

AU - Galvin, J. W.

AU - Freedman, Brett

AU - Schoenfeld, A. J.

AU - Cap, A. P.

AU - Mok, J. M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Introduction: The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients. Materials and methods: Patients were retrospectively categorized as stable or borderline unstable depending on the presence of at least one of the following: ISS >40, ISS >20 and chest injury, exploratory laparotomy or thoracotomy, lactate >2.5 mEq/L, platelet <110,000/mm3, or >10 U PRBCs transfused pre-operatively. Surgical morbidity, complications, and neurologic improvement between the two groups were compared retrospectively. Results: 30 casualties underwent 31 spine surgeries during a 12-month period. 16 of 30 patients met criteria indicating a borderline unstable patient. Although there were no significant differences in the procedures performed for stable and borderline unstable patients as measured by the Surgical Invasiveness Index (7.5 vs. 6.9, p = 0.8), borderline unstable patients had significantly higher operative time (4.3 vs. 3.0 h, p = 0.01), blood loss (1,372 vs. 366 mL, p = 0.001), PRBCs transfused intra-op (3.88 vs. 0.14 U, p < 0.001), and total PRBCs transfused in theater (10.18 vs. 0.31 U, p < 0.001). Conclusions: The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.

AB - Introduction: The optimal timing of surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed against the morbidity of surgery in the early post-injury period. The performance of spine surgery in the Afghanistan theater permits analysis of the morbidity of early surgery on military casualties. The objective is to compare surgical morbidity of early spinal surgery in multiply injured patients versus stable patients. Materials and methods: Patients were retrospectively categorized as stable or borderline unstable depending on the presence of at least one of the following: ISS >40, ISS >20 and chest injury, exploratory laparotomy or thoracotomy, lactate >2.5 mEq/L, platelet <110,000/mm3, or >10 U PRBCs transfused pre-operatively. Surgical morbidity, complications, and neurologic improvement between the two groups were compared retrospectively. Results: 30 casualties underwent 31 spine surgeries during a 12-month period. 16 of 30 patients met criteria indicating a borderline unstable patient. Although there were no significant differences in the procedures performed for stable and borderline unstable patients as measured by the Surgical Invasiveness Index (7.5 vs. 6.9, p = 0.8), borderline unstable patients had significantly higher operative time (4.3 vs. 3.0 h, p = 0.01), blood loss (1,372 vs. 366 mL, p = 0.001), PRBCs transfused intra-op (3.88 vs. 0.14 U, p < 0.001), and total PRBCs transfused in theater (10.18 vs. 0.31 U, p < 0.001). Conclusions: The results indicate that published criteria defining a borderline unstable patient may have a role in predicting increased morbidity of early spine surgery. The perceived benefits of early intervention should be weighed against the greater risks of performing extensive spinal surgeries on multiply injured patients in the early post-injury period, especially in the setting of combat trauma.

KW - Afghanistan war

KW - Combat spine trauma

KW - Military casualties

KW - Operation enduring freedom

KW - Polytrauma

KW - Spine fracture

KW - Spine surgery in theater

UR - http://www.scopus.com/inward/record.url?scp=84906349823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906349823&partnerID=8YFLogxK

U2 - 10.1007/s00402-014-2068-7

DO - 10.1007/s00402-014-2068-7

M3 - Article

C2 - 25077784

AN - SCOPUS:84906349823

VL - 134

SP - 1211

EP - 1217

JO - Archiv fur orthopadische und Unfall-Chirurgie

JF - Archiv fur orthopadische und Unfall-Chirurgie

SN - 0003-9330

IS - 9

ER -