Complications after Surgery for Traumatic Spinal Cord Injury in Côte D'ivoire: A Cohort of 345 Operated Patients

Background. Complications after surgery for traumatic spinal cord injury (SCI) remain poorly documented in sub-Saharan Africa. Objective. To describe postoperative complications (pressure sores, superinfection, reoperation) at an Ivorian referral centre and to look for a link with in-hospital mortality. Methods. Single-centre cohort (Bouaké Teaching Hospital), reported according to STROBE: 345 operated patients out of 366 with confirmed SCI. We extracted complications recorded before death or discharge; onset dates were not always known. The primary outcome was in-hospital mortality, analysed with Firth penalised logistic regression. Results. Median age was 35 years (IQR 25–48); 80.9% were men; median time to surgery was 3 days. In-hospital mortality reached 17.7% (61/345). At least one complication affected 59.4% of operated patients: neurological 25.5% (including 34 neurological worsenings), respiratory 21.4%, urinary 13.0%, pressure sore 12.5%, thromboembolic 4.1%; superinfection 17.4%. Reoperation concerned 6.7% (fixation or decompression revision:4.6%). All deaths occurred in patients with a complication (61/205 vs 0/140). Pressure sores did not differ significantly by severity (16.0% vs 10.0%; p = 0.10). After adjustment for age and complete injury (adjusted OR 7.03), pressure sore (5.58) and urinary (7.26), neurological (5.89) and respiratory (4.23) complications remained associated with mortality (p < 0.001). Conclusion. Complications are frequent and associated with mortality. Our data cannot tell whether they cause death, result from an already unfavourable course, or merely mark it. Prospective studies with dated complications, care-process indicators and fuller adjustment are needed before judging quality of care.