Time to surgery for unstable thoracolumbar fractures in Latin America- a multicentric study.

Abstract Objective To identify the delay for surgery to stabilize unstable thoracolumbar fractures and the main reasons for it across Latin America. Material and Methods We reviewed the charts of 547 patients with type B or C thoracolumbar fractures from 21 spine centers across nine Latin American countries. Data were collected on demographics, mechanism of trauma, time between hospital arrival and surgery, type of hospital (public vs. private), fracture classification, spinal level of injury, neurological status (AIS), number of levels instrumented, and reason for delay between hospital arrival and surgical treatment. Results The sample included 403 men (73.6%) and 144 women (26.3%), with a mean age of 40.6 years. The main mechanism of trauma was falls (44.4%), followed by car accidents (24.5%). The most frequent pattern of injury was B2 injuries (46.6%), and the most affected level was T12-L1 (42.2%). Neurological status at admission was 60.5% - intact and 22.9% AIS A. The time from admission to surgery was over 72 hours in over half the patients and over a week in more than 25% of them. The most commonly reported reasons for surgical delay were clinical instability (22.9%), lack of operating room availability (22.7%), and lack of hardware for spinal instrumentation (e.g., screws/rods) (18.8%). Conclusion Timing for surgery in this sample of unstable fractures was over 72 hours in more than half the sample and longer than a week in about a quarter. The main reasons for this delay were clinical instability and lack of economic resources. There is an apparent need for increased funding for the treatment of spinal trauma patients in Latin America.