Predictors of In-Hospital Mortality After Operative Cervical Spinal Cord Injury: A National Trauma Data Bank Analysis From 2021 to 2023.

Study DesignRetrospective cohort study.ObjectivesTo evaluate patient, injury, and hospital-level predictors of in-hospital mortality following operative management of cervical spinal cord injury (cSCI) using a national trauma registry.MethodsA retrospective cohort study was performed using the National Trauma Data Bank (NTDB) from 2021 to 2023. Adult patients with cSCI were identified using ICD-10-CM diagnosis codes and included if they underwent operative treatment at the cervical spine level. Patient and injury characteristics were assessed using the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). Hypotension and Glasgow Coma Scale (GCS) were used to characterize arrival physiology. Multivariable logistic regression identified independent predictors of in-hospital mortality, with significance set at the P < 0.05 level.ResultsAmong 18,401 operatively managed cSCI patients, 1,222 (7.1%) died in-hospital, with no variation across years (P = 0.827). Compared with survivors, decedents were older, more often male, and more frequently injured by falls (all P ≤ 0.007). Polytrauma and hypotension were more common among in-hospital deaths (both P < 0.001), and decedents demonstrated higher injury severity and worse presenting neurologic status (both P < 0.001). In adjusted analyses, mortality was independently associated with older age, higher ISS, worse GCS, hypotension, critical spine AIS severity, and polytrauma. Key comorbidity predictors included advanced directives limiting care, functional dependence, congestive heart failure, chronic renal failure, cirrhosis, diabetes mellitus, and anticoagulant therapy.ConclusionsIn-hospital mortality after operative cSCI was 7.1% and was driven by initial physiology, neurologic status, injury severity, and comorbidity burden.