Trends in Patient Care for Traumatic Spinal Injuries in the United States: A National Inpatient Sample Study of the Correlations With Patient Outcomes From 2001 to 2012.

STUDY DESIGN: A retrospective database review.

OBJECTIVE: The aim of this study was to examine whether patient characteristics, distribution of care, and patient outcomes for spinal cord injury (SCI) in the United States have changed between 2001 and 2012.

SUMMARY OF BACKGROUND DATA: Although patient outcomes after cranial injury are better at high-volume centers with specialized, multidisciplinary teams, similar assessments have not been done for spinal injuries.

METHODS: We retrospectively reviewed the National and Nationwide Inpatient Samples for the years 2001, 2002, 2011, and 2012 to identify patients with spinal fracture with or without SCI. The demographic characteristics of the patient cohort, clinical course, hospital characteristics, interhospital transfer, and disposition were statistically analyzed relative to patient mortality, total hospital costs, and length of stay. How these data changed over this 11-year period was also evaluated.

RESULTS: A total of 159,875 cases were identified, with 141,737 fractures without SCI and 18,138 SCIs with or without fracture. There was a statistically significant decrease in the percentage of patients transferred with spine injury from 4.2% to 3.4% (P < 0.001) from the early years to the later years and in patient transfers for SCIs (8.1% vs. 6.5%, P < 0.001). Interestingly, the overall mortality rate (3.5% vs. 3.6%) remained unchanged (P = 0.679), but mortality from SCI increased (6.6-7.4%, P = 0.021).

CONCLUSION: From 2002 to 2012, the rate of interhospital transfer of spinal injury patients declined, while the mortality rate for patients with SCI increased. Interestingly, there was an increase in transfers after spinal surgery at the index hospital. The decentralization of spine care may be responsible for the increase in mortality.

LEVEL OF EVIDENCE: 4.