Trends in management of central cord syndrome: Insights from the New York State SPARCS database

Multiple surgical and non-surgical management options exist for treating central cord syndrome (CCS) patients. However, the final treatment decision is based on a patient's presentation and surgeon's choice. We aim to identify patient factors associated with decisions for surgical management versus non-surgical management of CCS and compare the outcomes of length of stay (LOS), patient disposition, readmission, complications, mortality, and total cost. This retrospective analysis of the New York Statewide Planning and Research Cooperative System (SPARCS) database identified CCS patients from January 1, 2012, to December 31, 2021. Surgical treatments were determined using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. Chi-square, T-test, and multivariable regression were used to compare outcomes, with random intercepts and effects for facilities. P &lt; 0.05 was considered significant. Of 2214 patients, 41.24% (<i>n</i> = 891) underwent surgery. The majority (46.88%, <i>n</i> = 1038) were aged 40–65, followed by 46.48% (<i>n</i> = 1029) older than 65. Compared to non-surgically managed patients, surgically treated patients had a lower 90-day readmission rate, but a significantly longer length of stay, likelihood of non-home discharge, and total charge and cost. Of surgical modalities, posterior cervical decompression had the shortest mean LOS, probability of readmission, probability of readmission, and lowest mean total charge. Our study points toward surgery as having more favorable outcomes versus non-surgical management. The current study found that surgical management is associated with decreased probability of 90-day readmission and a non-significate decreased probability of mortality within 90 days of discharge.

治疗脊髓中央综合征（central cord syndrome, CCS）患者的外科与非外科干预方案均已具备，但最终治疗决策需结合患者临床表现与术者的临床判断。本研究旨在明确与CCS患者外科/非外科治疗决策相关的患者相关因素，并对比两类治疗方式在住院时长（length of stay, LOS）、患者出院去向、再入院率、并发症发生率、死亡率及总治疗成本方面的结局差异。本研究基于纽约州全域规划与研究合作系统（New York Statewide Planning and Research Cooperative System, SPARCS）数据库开展回顾性分析，纳入2012年1月1日至2021年12月31日期间确诊的CCS患者。外科治疗的判定依据国际疾病分类（International Classification of Diseases, ICD）与当前操作术语（Current Procedural Terminology, CPT）编码。本研究采用卡方检验、t检验及多因素回归分析进行结局对比，并纳入医疗机构的随机截距与随机效应，以P<0.05作为统计学显著性判定标准。本研究共纳入2214例患者，其中41.24%（n=891）接受外科手术治疗。患者年龄分布以40~65岁群体占比最高（46.88%，n=1038），其次为65岁以上群体（46.48%，n=1029）。与接受非外科治疗的患者相比，外科治疗患者的90天再入院率更低，但住院时长更长、非家庭出院的概率更高，且总诊疗收费与总成本均更高。在各类外科术式中，后路颈椎减压术的平均住院时长、再入院概率及平均总诊疗收费均为最低。本研究结果提示，相较于非外科治疗，外科干预可带来更优的临床结局。本研究发现，外科治疗与90天再入院率降低显著相关，且可使患者出院后90天内的死亡率呈无统计学意义的下降。