Abstract
Study design
Retrospective, cohort study of a prospectively collected database.
Objectives
In a cohort of patients with traumatic spine injury (TSI) in Tanzania who did not undergo surgery, we sought to: (1) describe this nonoperative population, (2) compare outcomes to operative patients, and (3) determine predictors of nonoperative treatment.
Setting
Tertiary referral hospital.
Methods
All patients admitted for TSI over a 33-month period were reviewed. Variables included demographics, fracture morphology, neurologic exam, indication for surgery, length of hospitalization, and mortality. Regression analyses were used to report outcomes and predictors of nonoperative treatment.
Results
270 patients met inclusion criteria, of which 145 were managed nonoperatively. Demographics between groups were similar. The nonoperative group was young (mean = 35.5 years) and primarily male (n = 125, 86%). Nonoperative patients had 7.39 times the odds of death (p = 0.003). Patients with AO type A0/1/2/3 fractures (p < 0.001), ASIA E exams (p = 0.016), cervical spine injuries (p = 0.005), and central cord syndrome (p = 0.016) were more commonly managed nonoperatively. One hundred and twenty-four patients (86%) had indications for but did not undergo surgery. After multivariate analysis, the only predictor of nonoperative management was sustaining a cervical injury (p < 0.001).
Conclusions
Eighty-six percent of nonoperative TSI patients had an indication for surgery. Nonoperative management was associated with an increased risk of mortality. Cervical injury was the single independent risk factor for not undergoing surgery. The principle reason for nonoperative management was cost of implants. While a causal relationship between nonoperative management and inferior outcomes cannot be made, efforts should be made to provide surgery when indicated, regardless of a patient’s ability to pay.
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Data availability
The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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NLL was responsible for statistical analysis, interpretation of the results, and writing the manuscript. AL was responsible for collection of data, interpretation of the results, and writing the manuscript. SLZ was responsible for conception of study design, interpretation of the results, and editing the manuscript. AL, NR, and HKS were responsible for interpretation of the results and editing the manuscript. RH was responsible for conception of study design, interpretation of the results, editing the manuscript, and supervision.
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Lessing, N.L., Lazaro, A., Zuckerman, S.L. et al. Nonoperative treatment of traumatic spinal injuries in Tanzania: who is not undergoing surgery and why?. Spinal Cord 58, 1197–1205 (2020). https://doi.org/10.1038/s41393-020-0474-y
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DOI: https://doi.org/10.1038/s41393-020-0474-y
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