Predictive Factors and Impact of Delayed Spine Surgery: A Nationwide Retrospective Cohort Publisher



S Zoghi SINA ; St Prvulovic Stefan T ; Cj Sabet Cameron JOHN ; A Warrier AKSHAY ; Sf Maroufi Seyed FARZAD ; Jm Roy Joanna MARY ; Mh Schmidt Meic HELMUT ; Ca Bowers Christian A ; Md Moisi Marc DANIEL
Source: Global Spine Journal Published:2025

Abstract

Study Design: Retrospective Cohort Study. Objectives: This study sought to analyze predictors of delayed spine surgery and their impact on postoperative adverse outcomes. Methods: This retrospective cohort study analyzed patients who underwent spine surgery from the National Surgical Quality Improvement Program database from 2015 to 2020. Delayed spine surgery was defined as the interval from admission to operation exceeding the 95th percentile of the total population or lasting >3 days. Multivariate regression models were used to estimate probabilities of outcomes after adjusting for individual risk factors. The primary outcome included mortality, along with secondary measures including nonroutine discharge, extended length of stay (LOS), major and minor postoperative complications, Clavien-Dindo grade IV complications (CDIV), readmission, and reoperation rates. Results: Of 362 788 patients, 16 664 (4.59%) experienced a delay in surgery. The adjusted odds ratios for outcomes predicted by delayed surgery were mortality (1.452, 1.251-1.685), nonroutine discharge destination (3.447, 3.285-3.618), extended LOS (3.650, 3.473-3.837), minor postoperative complications (1.462, 1.370-1.559), major postoperative complications (1.607, 1.511-1.709), Clavien-Dindo grade IV complications (1.469, 1.356-1.592), readmission (1.499, 1.401-1.604), and reoperation (1.420, 1.303-1.547). ROC analysis showed that GNRI has an excellent discriminative power (C-statistic = 0.801) for delayed surgery. There is little incremental gain from adding other indices including frailty and perioperative conditions and status to GNRI (C-statistic of the compound index = 0.809). Conclusions: Pre-operative delays in spine surgery independently predict increased postoperative morbidity and mortality. Surgical delay was associated with higher GNRI. These findings highlight the importance of timely surgeries to minimize complications and reduce healthcare costs. © 2025 Elsevier B.V., All rights reserved.