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Background context <p>Thoracic spine fractures are common in polytrauma patients and are frequently associated with high-energy trauma and severe systemic injury. Although early surgical stabilization may improve clinical outcomes by reducing complications and hospital stay, the optimal timing for intervention remains controversial. Evidence is limited regarding the impact of surgical timing in patients with varying injury severity scores.</p> Purpose <p>To investigate, in a cohort study, the relationship between surgical timing and clinical outcomes in polytrauma patients with thoracic spine fractures.</p> Study desing/setting <p>This was a retrospective cohort study performed at a Level 1 trauma center, involving consecutive patients with thoracic spine fractures who underwent surgical treatment between 2009 and 2015. All procedures were conducted by an experienced spine surgery team using standardized operative and perioperative protocols.</p> Patient sample <p>The study included 57 polytrauma patients with thoracic spine fractures who underwent surgical stabilization between 2009 and 2015. Patients were divided into four groups according to Injury Severity Score (≥ 25 vs. &lt; 25) and timing of surgery (&lt; 8&#xa0;h vs. &gt; 8&#xa0;h).</p> Outcomes measures <p>The primary outcome was hospital length of stay, used as a surrogate for clinical recovery. Secondary outcomes included ICU length of stay, volume of blood transfused, number of vertebral segments stabilized, postoperative complications, and in-hospital mortality. These measures were selected to assess the impact of surgical timing on short-term clinical outcomes.</p> Methods <p>A total of 57 polytrauma patients who underwent surgical treatment for thoracic spine fractures were included in the study. Patients were categorized based on two variables: time to surgery (early: &lt;8&#xa0;h vs. late: &gt;8&#xa0;h) and Injury Severity Score (ISS) upon admission (high: ≥25 vs. low: &lt;25), resulting in four distinct groups. Key variables analyzed included blood transfusions, number of fixation segments, surgery-related complications, and length of hospital and Intensive Care Unit (ICU) stays.</p> Results <p>Comparison of groups with similar ISS revealed that patients in the early surgery groups experienced significantly reduced hospitalization duration. Furthermore, statistical analysis indicated a significant positive correlation between hospitalization length and both the volume of blood transfused and the number of vertebral segments stabilized.</p> Conclusion <p>This study adds valuable insight into optimal management strategies for thoracic spine fractures in polytrauma patients. Our findings suggest that early surgical intervention is associated with improved clinical outcomes, highlighting the importance of timely treatment in enhancing patient recovery.</p>

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Early vs. late surgery in thoracic spine fractures: impact on clinical outcomes in polytrauma patients

  • 期刊论文

  • 发表日期：

    2025年11月14日

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  • Gustavo Sardinha Lisboa Leite,
  • Diego Olandoski de Oliveira,
  • Mariana Demétrio de Sousa Pontes,
  • Carlos Fernando Pereira da Silva Herrero

摘要

Background context

Thoracic spine fractures are common in polytrauma patients and are frequently associated with high-energy trauma and severe systemic injury. Although early surgical stabilization may improve clinical outcomes by reducing complications and hospital stay, the optimal timing for intervention remains controversial. Evidence is limited regarding the impact of surgical timing in patients with varying injury severity scores.

Purpose

To investigate, in a cohort study, the relationship between surgical timing and clinical outcomes in polytrauma patients with thoracic spine fractures.

Study desing/setting

This was a retrospective cohort study performed at a Level 1 trauma center, involving consecutive patients with thoracic spine fractures who underwent surgical treatment between 2009 and 2015. All procedures were conducted by an experienced spine surgery team using standardized operative and perioperative protocols.

Patient sample

The study included 57 polytrauma patients with thoracic spine fractures who underwent surgical stabilization between 2009 and 2015. Patients were divided into four groups according to Injury Severity Score (≥ 25 vs. < 25) and timing of surgery (< 8 h vs. > 8 h).

Outcomes measures

The primary outcome was hospital length of stay, used as a surrogate for clinical recovery. Secondary outcomes included ICU length of stay, volume of blood transfused, number of vertebral segments stabilized, postoperative complications, and in-hospital mortality. These measures were selected to assess the impact of surgical timing on short-term clinical outcomes.

Methods

A total of 57 polytrauma patients who underwent surgical treatment for thoracic spine fractures were included in the study. Patients were categorized based on two variables: time to surgery (early: <8 h vs. late: >8 h) and Injury Severity Score (ISS) upon admission (high: ≥25 vs. low: <25), resulting in four distinct groups. Key variables analyzed included blood transfusions, number of fixation segments, surgery-related complications, and length of hospital and Intensive Care Unit (ICU) stays.

Results

Comparison of groups with similar ISS revealed that patients in the early surgery groups experienced significantly reduced hospitalization duration. Furthermore, statistical analysis indicated a significant positive correlation between hospitalization length and both the volume of blood transfused and the number of vertebral segments stabilized.

Conclusion

This study adds valuable insight into optimal management strategies for thoracic spine fractures in polytrauma patients. Our findings suggest that early surgical intervention is associated with improved clinical outcomes, highlighting the importance of timely treatment in enhancing patient recovery.