Impact of surgical delay on 30-day reoperation rates and length of stay after anterior fixation of odontoid fractures.

BACKGROUND

Surgical management of odontoid fractures in the cervical spine is utilized to promote higher fusion rates, reduce medical complications, and limit mortality. Delay in surgical management of operative odontoid fractures after hospital admission, however, may be associated with greater rates of adverse events and length of stay. We sought to evaluate the effect of surgical delay on unplanned reoperation and increased length of stay following anterior fixation of odontoid fractures.

MATERIALS AND

METHODS

A retrospective observational study was conducted on patients who underwent anterior fixation for an odontoid fracture from 2013 to 2022, utilizing the National Surgical Quality Improvement Program database. Eligibility for inclusion was age >18 years and current procedural terminology codes 22,318 and 22,319. Outcomes, including length of stay, mortality, and reoperation, were compared between cohorts. Prolonged time between hospital admission and surgery ≥48 h was assessed as a predictor of clinical outcomes.

RESULTS

Among 265 patients, 85 (32.1%) had a surgical delay. Age, sex, race, body mass index, and other medical comorbidities were statistically similar at baseline between groups. Surgical delay was associated with greater length of stay (8.2 vs. 4.5 days, P = 0.012) and unplanned reoperation (11.8% vs. 3.3%, P = 0.011), and trended toward association with readmission (9.4% vs. 3.3%, P = 0.072). Multivariate Poisson regression demonstrated that surgical delay independently predicted length of stay (χ 2 = 257.75, P < 0.001) and unplanned reoperation (χ 2 = 5.24, P < 0.001), but not readmission (χ 2 = 3.21, P = 0.073).

CONCLUSION

Surgical delay was an independent and significant predictor of increased length of stay and reoperation. These results suggest that surgery should be performed promptly within 48 h when indicated to minimize the risk of adverse outcomes.