Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia

Abstract

Study design

Retrospective cohort study.

Objectives

We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI).

Setting

All specialized hospitals of Saint Petersburg.

Methods

We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012–2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan–Meier method and calculated relative risks (RRs).

Results

A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2–1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15–22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3–2.1) and mortality (RR = 2.2, 95% CI: 1.6–3.1).

Conclusion

Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS.

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Fig. 1: Complications during the hospitalisation.
Fig. 2: Clinical features and complications.
Fig. 3: Complications and survival.

Data availability

The datasets generated and analysed during the current study are available from the corresponding author on request.

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Acknowledgements

We thank A. Dulaev, T. Skoromets, V. Dorofeev, S. Petrov, Y. Linets, G. Sokurenko, and V. Rybnikov for their help in finding medical records. We are grateful to statistician O. Klicenko for her help.

Funding

The study was supported by a grant from the Norwegian Centre for International Cooperation in Education.

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Authors

Contributions

LM was responsible for searching for and collecting data, statistical analysis, the literature search, and preparation and revision of the paper. SL was responsible for the design, organization, and management of the research and approval of the final version. NT was responsible for organization, the literature search, and revision of the paper. AS was responsible for obtaining information from the Health Care Committee and hospitals. NEG was responsible for preparation and revision of the paper, evaluation of methods, and approval of the final version. TR was responsible for study design, creating tables and figures, the literature search, interpreting the results, and preparation and revision of the paper.

Corresponding author

Correspondence to Tiina Rekand.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Research Ethics Committee of the North-Western State Medical University, named after I.I. Mechnikov, Saint Petersburg, Russia (No 10/date 09.11.2016).

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Mirzaeva, L., Lobzin, S., Tcinzerling, N. et al. Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-0458-y

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