Time to Surgery for Subaxial Cervical Fractures: A Multicenter Study.

Objective: To identify delays for surgery to stabilize subaxial cervical fractures and the main reasons for them across Latin America.

Methods: This is a retrospective multicenter cohort study of patients surgically treated for subaxial cervical fractures from 13 spine centers across Latin America from January 1, 2014 to January 1, 2023. Causes of delay to surgery beyond 24 hours were documented.

Results: We included 529 patients from 13 institutions in Latin American countries; 408 (77.1%) males and 121 (22.9%) females with a mean age of 43.4 (standard deviation = ±16.2). Predominantly caused by traffic accident (n = 256; 48.4%), followed by fall from height (n = 233; 44%). Mostly, suffered type C fractures (n = 348; 65.8%) and/or neurological injury (n = 384; 72.6%). The time from admission to surgery was >72 hours in 70% of the patients included (n = 375; 70.9%). More than 45% waited longer than a week (n = 257; 48.6%) for spine surgery. Only 12.5% (n = 66) of the patients received surgery in the first 24 hours from admission. The primary reasons for the surgical delay were the necessity for other surgical procedures (n = 161; 34.8%), the unavailability of surgical implants (n = 60; 13.0%), patient clinical instability (n = 55; 11.9%), and delays in referral (n = 38; 8.2%).

Conclusions: We documented significant and concerning delays in providing spinal decompression and stabilization surgery to patients with cervical spine fractures. Only 17% of patients have surgery in the recommended time <24 hours, more than half of the patients must wait for more than 72 hours, and nearly half of patients wait for longer than a week.