Predictors of Surgical Delay and Its Impact on Outcomes in Surgery for Degenerative Cervical Myelopathy: Analysis of a National Prospective Registry (2015–2020)

Introduction: This study investigates predictors of surgical delay (PSD) in degenerative cervical myelopathy (DCM) surgery patients and how PSD impacts DCM outcomes, utilizing a prospective national surgical registry from 2015 to 2020.

Methods: All the patients who underwent surgery for DCM between the years 2015 and 2020, using the ACS-NSQIP database. Outcomes evaluated in this study include Mortality, Non-routine Discharge (NRD), extended Length of Stay (eLOS), complications, 30-day unplanned readmission, and reoperation. Logistic regression analysis, adjusted for American Society of Anesthesiologists (ASA) classification, Risk Analysis Index (RAI), Geriatric Nutritional Risk Index (GNRI), race, ethnicity, age, and operation time were used to evaluate the relationship between operation delay and postoperative outcomes.

Results: There were 8,553 cranial surgery patients, with 3,706 (43.3%) and 4,847 (56.7%) female and white patients, respectively. There were 6,929 (81.0%) surgeries and neurosurgeons performed the vast majority (76.2% or 6,515 patients). Surgical Delay (SD) is defined as a delay over the 95th percentile, which was 5 days, and 354 (5.0%) patients had a delay of more than 5 days. Adverse outcomes consisted of mortality, NRD, eLOS, occurrence complication, CDIV complication, unplanned readmission, and reoperation, and were experienced by 45 (0.5%), 1,722 (20.2%), 2,225 (26.0%), 668 (7.8%), 252 (2.9%), 527 (6.2%), and 248 (2.9%), respectively.
AUCs of RAI, ASA, PASC, albumin level, and GNRI were 0.675 (0.6440.706), 0.693 (0.667-0.719), 0.512 (0.481-0.544), 0.823 (0.799-0.846), and 0.727 (0.699-0.755), respectively. A recalibration of GNRI for DCM was carried out (AUC= 0.825; 0.802-0.849) which failed to show significant improvement over albumin level alone. aOR of SD was 3.968 (3.027-5.201), 3.049 (2.351-3.954), and 1.416 (1.026-1.954) for NRD, eLOS, and Complication. However, SD was not significantly associated with mortality, CDIV complication, Unplanned readmission, and reoperation after adjusting for potential confounders in logistic regression analysis.

Conclusion : SD in DCM patients is significantly associated with worse discharge outcomes, longer hospital stays, and increased complications, underscoring the importance of timely intervention. However, SD did not significantly impact mortality, CDIV complications, readmission, or reoperation after adjustment.