Delay in Surgical Fixation of Operatively Treated Thoracolumbar Fractures in the Elderly Associated With Minimal Increase in Short-Term Complications

Study DesignRetrospective cohort study.ObjectivesOptimal timing of surgical fixation for neurologically intact unstable thoracolumbar fractures (NIUTLFx) in elderly patients remains poorly defined. This study evaluated the association between delay to surgical fixation and short-term postoperative outcomes in elderly patients with NIUTLFx.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients aged 60 years or older who underwent operative fixation for unstable NIUTLFx between 2012 and 2023. Multivariable logistic regression and change-point analyses were used to evaluate the association between surgical delay and 30-day mortality, major complications, perioperative transfusion, and discharge disposition, adjusting for demographic and clinical covariates.ResultsA total of 976 patients met inclusion criteria. The mean time to surgery was 2.8 ± 2.0 days. Surgical delay was not associated with increased 30-day mortality or major postoperative complications. Delays exceeding four days were independently associated with a higher likelihood of discharge to a non-home destination (odds ratio 1.60, 95% CI 1.07-2.38). Delay was not an independent predictor of perioperative blood transfusion after adjustment. Over the study period, mean time to surgery decreased significantly, reflecting a national trend toward earlier operative intervention.ConclusionsIn elderly patients with NIUTLFx, surgical delays of up to four days do not increase short-term mortality or major complications. However, delays beyond four days are associated with a significantly increased risk of non-home discharge. Our data suggest that over short timescales, surgical fixation delays are not associated with significant morbidity but are associated with worse discharge disposition.