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Delay in Surgery May Be a Cause of Respiratory Failure in Spinal Fracture Patients: Presented at AAOS

By John Otrompke

CHICAGO, I.L. – March 27, 2006 -- A retrospective review of almost 5,000 patients with spinal fractures found a greater than tripled likelihood of respiratory failure in cases in which surgery was delayed past 2 days.

The findings confirmed prior studies which had found lower incidence of pneumonia and reduced intensive care unit (ICU) stays among patients who received early treatment for femoral fractures, according to LTC Timothy P. McHenry, MD, chief of spine surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, United States.

"The predictive likelihood of respiratory failure was.021% if the patient had no risk factors," Dr. McHenry said in his presentation on at the annual meeting of the American Academy of Orthopedic Surgeons (AAOS). He noted that the review indicated a sharp increase in respiratory failure between patients who had surgery on the second day after a spinal fracture and those who had surgery on the third day, with an increase in incidence of 6 to 13 patients.

Of 4901 patients treated for spinal fractures at University of Washington Harborview Medical Center over a 19-year-period beginning in 1985, 1209 patients who underwent surgical stabilization formed the basis of the cohort (although 177 were excluded due to incomplete record keeping).

Of the patients in the entire cohort, 23 died, Dr. McHenry said.

"This study seems to confirm results of trials from the 1980s, which indicated that early stabilization of patients decreased the incidence of respiratory failure, because patients didn't have the problem of recumbency and prolonged bed-rest. The theory was that being able to mobilize earlier provided the patient access to respiratory care," he said.

The retrospective study did not assort causal force to multiple variables, such as blood transfusions, smoking status, or hypotension.

"I don't think we had an accurate look at smoking as a factor, because in a large trauma database, some things are mandatory to enter, but smoking was not," Dr. McHenry explained. "Only 6.1% of the patients in our study smoked, compared to 22.5% nationally."

He noted that work in the military was not a criterion for patients in the review.


[Presentation title: Risk Factors for Respiratory Failure Following Operative Stabilization of Thoracolumbar Fractures. Abstract 190]

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