Did the Covid-19 Pandemic Impact Time to Surgery, Length of Hospital Stay, or Discharge Location for Subaxial Cervical Spine Fractures Requiring Surgical Intervention?

Background: The COVID-19 pandemic disrupted healthcare systems across the United States resources were consumed caring for COVID-19 patients. Past research on trauma activations during COVID-19 has found changes to hospital length of stay and discharge locations. Subaxial spine fractures are potentially debilitating injuries that require timely surgery and extensive rehabilitation. Accordingly, the objective of this study was to compare the severity of cervical spine injuries, time to surgery, hospital length of stay, and discharge disposition for patients presenting during COVID-19. Methods: 128 patients with subaxial fractures from a Level One Adult Trauma Center that required surgical intervention were reviewed. The primary outcomes included hospital length of stay, ICU days, time to surgery, complications, and discharge location in patients with subaxial cervical fractures during COVID-19 pandemic versus immediately before the pandemic. Results: When comparing the pre-COVID-19 period to the COVID-19 group, there was no difference in time to surgery or overall length of stay (2.47 vs. 2.35 days and 12.93 vs. 13.82 days, p>0.05). There was no difference in number of patients discharged home during COVID-19 (41% (32/79) vs. 37% (18/49) p>0.05) or patients discharged to hospital rehab (33%, (26/79) vs. 35% (17/49), p>0.05). A similar percentage of patients had complications within 90 days of discharge (16% (12/75) vs. 22% (10/46), p>0.05). Conclusion: Despite the burden COVID-19 placed on healthcare systems, it did not affect post-operative hospital course of subaxial fracture patients with potentially debilitating injuries. This vulnerable subset of patients presenting during COVID-19 was still able to undergo timely surgery, have an appropriate hospital length of stay, and be discharged to rehabilitation centers. In future stresses to the healthcare system, deferring elective and non-emergent procedures can allow proper care for emergencies such as subaxial fractures. Level of Evidence: II.