Epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China: a hospital-based retrospective study

Author:

Zhou Hengxing12,Lou Yongfu13,Chen Lingxiao24,Kang Yi3,Liu Lu5,Cai Zhiwei6,Anderson David B.78,Wang Wei2,Zhang Chi2,Wang Jinghua9,Ning Guangzhi3,Gao Yanzheng10,He Baorong5,Ding Wenyuan11,Wang Yisheng12,Mei Wei13,Song Yueming14,Zhou Yue15,Xia Maosheng16,Wang Huan17,Zhao Jie18,Yin Guoyong19,Zhang Tao20,Jing Feng21,Zhu Rusen22,Meng Bin23,Duan Li24,Zhang Zhongmin25,Wu Desheng26,Cai Zhengdong27,Huang Lin28,Yin Zhanhai29,Li Kainan30,Lu Shibao31,Feng Shiqing123ORCID

Affiliation:

1. Department of Orthopedics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China

2. Department of Orthopedics, Shandong University Center for Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China

3. Department of Orthopedics, Tianjin Medical University General Hospital, International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin, China

4. Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, University of Sydney, Sydney, NSW, Australia

5. Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China

6. Department of Burns and Plastic Surgery, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China

7. Faculty of Medicine and Health, School of Health Sciences, University of Sydney, NSW, Australia

8. Sydney Spine Institute, Burwood, Sydney, NSW, Australia

9. Laboratory of Epidemiology, Tianjin Neurological Institute, Department of Neurology, Tianjin Medical University General Hospital & Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China

10. Department of Orthopedics, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China

11. Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China

12. Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

13. Department of Spine Surgery, Zhengzhou Orthopedics Hospital, Zhengzhou, Henan Province, China

14. Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

15. Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China

16. Department of Orthopedics, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China

17. Department of Spinal Surgery, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China

18. Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

19. Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China

20. Department of Spinal Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

21. Department of Spinal Surgery, Tianjin Hospital, Tianjin, China

22. Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, China

23. Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China

24. Department of Orthopedics, Shenzhen Intelligent Orthopedics and Biomedical Innovation Platform, Guangdong Artificial Intelligence Biomedical Innovation Platform, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, Guangdong Province, China

25. Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, China

26. Department of Spine Surgery, Shanghai East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China

27. Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

28. Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China

29. Department of Orthopedics, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China

30. Department of Orthopedic Surgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province, China

31. Department of Orthopedics, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China; National Geriatric Diseases Research Center, Beijing, China

Abstract

Abstract JOURNAL/nrgr/04.03/01300535-202405000-00044/inline-graphic1/v/2023-09-28T063346Z/r/image-tiff Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death. China has the largest population of patients with traumatic spinal cord injury. Previous studies of traumatic spinal cord injury in China have mostly been regional in scope; national-level studies have been rare. To the best of our knowledge, no national-level study of treatment status and economic burden has been performed. This retrospective study aimed to examine the epidemiological and clinical features, treatment status, and economic burden of traumatic spinal cord injury in China at the national level. We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China. Patient epidemiological and clinical features, treatment status, and total and daily costs were recorded. Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program. The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall (annual percentage change, –0.5% and 2.1%, respectively). A total of 10,053 (74.7%) patients underwent surgery. Only 2.8% of patients who underwent surgery did so within 24 hours of injury. A total of 2005 (14.9%) patients were treated with high-dose (≥ 500 mg) methylprednisolone sodium succinate/methylprednisolone (MPSS/MP); 615 (4.6%) received it within 8 hours. The total cost for acute traumatic spinal cord injury decreased over the study period (–4.7%), while daily cost did not significantly change (1.0% increase). Our findings indicate that public health initiatives should aim at improving hospitals’ ability to complete early surgery within 24 hours, which is associated with improved sensorimotor recovery, increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

Publisher

Medknow

Subject

Developmental Neuroscience

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