Mortality after traumatic spinal cord injury in Galicia, Spain.

OBJECTIVES

To analyze mortality, causes of death and survival in patients with traumatic spinal cord injury (TSCI) in Galicia after discharge; compare global mortality and cause-specific mortality against the Galician population; and describe risk factors for mortality.

STUDY

DESIGN

A retrospective cohort study.

SETTING

A spinal cord injury Unit from a tertiary referral hospital.

METHODS

A cohort of TSCI patients discharged between January 2011 and December 2021. Causes of death (ICD-10) and survival time were obtained from the electronic health record. Global mortality and cause-specific mortality were compared with the Galician population using standardized mortality ratios (SMR). Survival was analyzed using the Kaplan-Meier method. Risk factors were studied using a Cox proportional hazards regression model.

RESULTS

A total of 438 patients were included (74.89% men), of whom 122 died by 30 June 2024. Mean survival time was 122 months. Survival was decreased in older patients, those with complete cervical injuries and women. TSCI patients had an increased mortality (SMR 2.2) compared with the Galician population. The most common causes of death were respiratory diseases. Cause-specific SMRs were significantly increased for respiratory diseases (SMR 10.22), urinary tract diseases (SMR 16.92) and pressure ulcers (SMR 37.74). Risk factors for mortality were mechanical ventilation or tracheostomy at discharge, having an indwelling catheter at discharge, and destination place at discharge different from the patient´s previous home.

CONCLUSIONS

TSCI patients in Galicia, especially women and older patients, have an increased mortality. Respiratory diseases are the most common cause of death. Special attention should be paid to respiratory management and destination after discharge.