| Variable | N | Rate of Surgery (%) | OR (95% CI) | P |
|---|---|---|---|---|
| Total cohort | 91,130 | 18,656 (20.5%) | ||
| Patient characteristics | ||||
| Mean age | NA | NA | 0.9990 (0.998–0.999) | 0.005 |
| Gender | ||||
| Male | 62,427 | 12,938 (20.7%) | 1.05 (1.01–1.09) | 0.005 |
| Female | 28,703 | 5718 (19.9%) | 1 | |
| Rate/Ethnicity | <0.001 | |||
| White | 70,546 | 14,694 (20.8%) | 1 | |
| Black | 10,318 | 1950 (18.9%) | 0.89 (0.84–0.93) | <0.001 |
| Hispanic | 10,266 | 2012 (19.6%) | 0.93 (0.88–0.98) | 0.004 |
| ≥1 comorbidity* | ||||
| Yes | 7358 | 1475 (20.0%) | 0.97 (0.92–1.03) | 0.35 |
| No | 83,772 | 17,181 (20.5%) | 1 | |
| Insurance status | ||||
| Insured | 71,938 | 15,253 (21.2%) | 1.25 (1.20–1.30) | <0.001 |
| Uninsured | 19,192 | 3403 (17.7%) | 1 | |
| Injury characteristics | ||||
| Neurological status | ||||
| SCI | 5562 | 3686 (66.3%) | 9.27 (8.74–9.83) | <0.001 |
| No SCI | 85,568 | 14,970 (17.5%) | 1 | |
| Fracture Location | <0.001 | |||
| Cervical | 27,985 | 6336 (22.7%) | 1 | |
| Thoracolumbar | 56,163 | 10,714 (19.1%) | 0.81 (0.78–0.83) | <0.001 |
| Multilevel | 6982 | 1606 (23.0%) | 1.02 (0.96–1.09) | 0.52 |
| Injury type | ||||
| Blunt | 89,450 | 18,498 (20.7%) | 2.51 (2.13–2.98) | <0.001 |
| Penetrating | 1680 | 158 (9.4%) | 1 | |
| Injury intent | <0.001 | |||
| Unintentional | 87,291 | 18,138 (20.8%) | 1 | |
| Assault | 2890 | 266 (9.2%) | 0.39 (0.34–0.44) | <0.001 |
| Self-inflicted | 736 | 207 (27.9%) | 1.49 (1.26–1.76) | <0.001 |
| Mechanism of injury | <0.001 | |||
| MVT | 46,686 | 8881 (19.0%) | 1 | |
| Fall | 27,997 | 6578 (23.5%) | 1.31 (1.26–1.36) | <0.001 |
| Transport, other | 8956 | 1924 (21.5%) | 1.16 (1.10–1.23) | <0.001 |
| Struck by/against | 3766 | 692 (18.4%) | 0.96 (0.88–1.04) | 0.33 |
| Firearm | 1407 | 138 (9.8%) | 0.46 (0.38–0.55) | <0.001 |
| Hemodynamic status† | ||||
| Shock | 1569 | 490 (31.2%) | 1.78 (1.60–1.99) | <0.001 |
| No shock | 89,561 | 18,166 (20.3%) | 1 | |
| Mean GCS | NA | NA | 0.9956 (0.990–1.001) | 0.10 |
| Hospital care | ||||
| Transfer status‡ | ||||
| Transferred | 28,866 | 7647 (26.5%) | 1.68 (1.62–1.73) | <0.001 |
| Not transferred | 62,264 | 11,009 (17.7%) | 1 | |
| Hospital nonprofit status | ||||
| For profit | 6960 | 1548 (22.2%) | 1.12 (1.06–1.19) | <0.001 |
| Nonprofit | 84,170 | 17,108 (20.3%) | 1 | |
| Hospital teaching status | ||||
| Teaching | 45,833 | 10,291 (22.5%) | 1.28 (1.24–1.32) | <0.001 |
| Non-teaching | 45,297 | 8365 (18.5%) | 1 | |
Note: Percentages may not add to 100% due to rounding or due to exclusion of variable categories with negligible frequency. Cervical indicates ≥1 cervical fracture; GCS, Glasgow Coma Scale in the Emergency Department; multilevel, ≥1 cervical fracture and ≥1 thoracolumbar fracture; MVT, motor vehicle traffic; NA, not applicable; OR, unadjusted odds ratio representing relative likelihood of having surgery; SCI, spinal cord injury; thoracolumbar, ≥1 thoracolumbar fracture.
*
Comorbidity categorized using the Deyo–Charlson Comorbidity Index (see text for details).
†
Shock is defined as systolic blood pressure <90 mm Hg in the Emergency Department.
‡
“Transferred” indicates patients transferred in from an outside acute care facility.