In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis.

Authors

• Mohsen Sadeghi-Naini
• Mahmoud Yousefifard
• Zahra Ghodsi
• Amir Azarhomayoun
• Fatemeh Kermanian
• Mehdi Golpayegani
• Seyed Danial Alizadeh
• Mostafa Hosseini
• Farhad Shokraneh
• Khalil Komlakh
• Alexander R Vaccaro
• Fan Jiang
• Michael G Fehlings
• Vafa Rahimi-Movaghar

Publication/Presentation Date

9-1-2023

Abstract

PURPOSE: To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.

METHODS: We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries).

RESULTS: Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028).

CONCLUSION: A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.

Volume

165

Issue

9

First Page

2675

Last Page

2688

ISSN

0942-0940

Published In/Presented At

Sadeghi-Naini, M., Yousefifard, M., Ghodsi, Z., Azarhomayoun, A., Kermanian, F., Golpayegani, M., Alizadeh, S. D., Hosseini, M., Shokraneh, F., Komlakh, K., Vaccaro, A. R., Jiang, F., Fehlings, M. G., & Rahimi-Movaghar, V. (2023). In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis. Acta neurochirurgica, 165(9), 2675–2688. https://doi.org/10.1007/s00701-023-05720-5

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

37480505

Department(s)

Administration and Leadership

Document Type

Article