Early fixation versus delayed fixation in cervical spine trauma patient with absent cough reflex in view of intensive care unit stay and cost effectiveness

Background: This study was conducted in GMC Jammu to evaluate ICU stay and cost effectiveness in patients with cervical spine trauma undergoing early fixation (within 24-72 hours after trauma) versus late fixation (delayed fixation after applying traction and waiting for return of cough reflex).Methods: Retrospective and prospective study was done by collecting data from admission register and patient follow-up during 2016-2019. 50 patients were admitted as cervical spine trauma, out of which 38 were operated upon and ten managed conservatively. 15 patients were operated within 72 hours of admission with absent cough reflex and 23 were put on cervical traction and operated upon after return of cough reflex.Results: Average ICU stay for 15 patients (4 females 11 males) immediately operated ranged from 10 to 15 days along with prolonged mechanical ventilation. Average ICU stay for 23 patients (16 males and 7 females) operated after returning of cough reflex ranged from 3-4 days with considerably decreased requirement of mechanical ventilation.Conclusions: Delayed fixation of cervical spine after returning of cough reflex shortens post-operative ICU stay and is considerably more cost effective than early fixation.