Spinal Cord Infarction Outcomes with a Focus on Thrombolysis: A Nationwide Database Study

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Abstract Background Spinal cord infarction (SCI) is a rare and challenging condition to diagnose. The literature lacks large studies examining the characteristics and outcomes of SCI. Treatments, such as thrombolysis, which are considered standard of care in cerebral stroke, have not been previously studied in SCI. The primary aim was to determine outcomes of hospitalizations with SCI in the United States (US) by assessing inpatient mortality and all-cause 30-day and 90-day readmissions. After adjusting for age and comorbidity burden, we analyzed if these outcomes differed based on thrombolysis, and the most common concomitant conditions, such as aneurysms, dissections and sepsis. Methods Hospitalizations of patients over 18 years of age with SCI were abstracted from the 2016-2021 Nationwide Readmissions Database (NRD). We estimated logistic and lognormal regression models to evaluate whether outcomes differed based on thrombolysis, or concomitant aneurysm, dissection, or sepsis. Multivariable models adjusted for age and comorbidity burden. Results An estimated 12,548 hospitalizations involved patients diagnosed with SCI; of those, 21.43% were specifically for SCI. Other common reasons for SCI hospitalization included aneurysms or dissections (22.22%) and sepsis (9.11%). The average LOS was 13.09 days (95% CI: 12.61-13.59), with an inpatient mortality rate of 14.66% (95% CI: 13.74-15.59). Age and comorbidity burden significantly impacted inpatient mortality, LOS, and hospital costs. Hospitalizations of patients with SCI were predominately at large bed size facilities (72.36%, Weighted N: 9,079) and metropolitan teaching hospitals (86.57%, Weighted N: 10,862). Thrombolysis was associated with lower odds of 90-day readmissions (adjusted OR=0.35, p-value= 0.009) and no significant difference in mortality. Concomitant sepsis significantly increased mortality, LOS, cost, and readmission odds. Conclusions This study highlights factors that impact the outcomes of SCI on a large scale. Additionally, the findings uncover the association between thrombolysis and better long-term outcomes in SCI. This paves the way for further investigation into the role of thrombolysis in SCI.

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