National trends in the management of central cord syndrome: An analysis of 16,134 patients

Background context Central cord syndrome (CCS) is a common cause of incomplete spinal cord injury. However, to date, national trends in the management and mortality after CCS are not fully understood. Purpose To analyze how patient, surgical, and institutional factors influence surgical management and mortality after CCS. Study design A retrospective cohort analysis. Patient sample The Nationwide Inpatient Sample (NIS) was queried for records of patients with a diagnosis of CCS from 2003 to 2010. Outcome measures They included in hospital mortality and surgical management, including anterior cervical decompression and fusion (ACDF), posterior cervical decompression and fusion (PCDF), and posterior cervical decompression (PCD). Methods Using International Classification of Diseases, Ninth Revision, Clinical Modification codes, patient records with a diagnosis of CCS from 2003 to 2010 were selected from the NIS database and sorted by inpatient mortality and surgical management. Demographic information (age, gender, and race) and hospital characteristics were evaluated with χ²-tests for categorical variables and t tests for continuous variables. Multivariate logistic regression models controlled for confounding. Results In this sample of 16,134 patients, a total of 39.7% of patients (6,351) underwent surgery. ACDF was most common (19.4%), followed by PCDF (7.4%) and PCD (6.8%). From 2003 to 2010, surgical management increased by an average of 40% each year. The overall inpatient mortality rate was 2.6%. Increasing age and comorbidities were associated with higher rates of patient mortality and a decreasing surgical rate (p<.01). Hospitals greater than 249 beds (p<.01) and the south (p<.01) were associated with a higher surgical rate. Rural hospitals (p<.01) and people in the second income quartile (p<.01) were associated with higher inpatient mortality. Conclusions Elderly patients with medical comorbidities are associated with a lower surgical rate and a higher mortality rate. Surgical management was more prevalent in the south and large hospitals. Mortality was higher in rural hospitals. It is important for surgeons to understand how patient, surgical, and institutional factors influence surgical management and mortality.