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Paraplegic and quadriplegic patients undergoing emergency abdominal surgery: Sicker presentations, worse outcomes

Benjamin, Elizabeth MD, PhD; Haltmeier, Tobias MD; Karamanos, Efstathios MD; Inaba, Kenji MD; Lam, Lydia; Demetriades, Demetrios MD, PhD

Journal of Trauma and Acute Care Surgery: April 2015 - Volume 78 - Issue 4 - p 808–815
doi: 10.1097/TA.0000000000000575
Original Articles

BACKGROUND Patients with paraplegia or quadriplegia presenting with abdominal surgical emergencies pose major clinical challenges. Difficulties in prompt diagnosis and treatment may influence patient outcomes.

METHODS This is an American College of Surgeons National Surgical Quality Improvement Program study of patients undergoing an emergent abdominal operation. Patients were stratified into paraplegic (PARA), quadriplegic (QUAD), and control (CONT). PARA and QUAD groups were matched with controls by 1:2 ratio. Regression models were used to analyze the effect of paraplegia and quadriplegia on outcome.

RESULTS A total of 76,766 patients underwent emergent abdominal operations: 274 PARA, 132 QUAD, and 76,356 CONT patients. Lower gastrointestinal operations were the most common procedures in PARA and QUAD groups; appendectomy was the most common in the CONT group. After cohort matching, patients with cord paralysis were significantly more likely to present with severe sepsis, have “infected” wounds at operation, and have increased rates of postoperative sepsis and need for reoperation.

CONCLUSION Patients with paraplegia or quadriplegia with acute abdominal surgical emergencies are more likely to present late and have a significantly higher incidence of postoperative septic complications and longer hospital stay. Early surgical consultation and aggressive evaluation and postoperative management are warranted in these populations.

LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV.

Supplemental digital content is available in the text.

Submitted: August 18, 2014, Revised: November 27, 2014, Accepted: November 28, 2014, Published online: March 4, 2015.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Demetrios Demetriades MD, PhD, Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo St, Inpatient Tower Room C5L-100, Los Angeles, CA 90033; email:

© 2015 Lippincott Williams & Wilkins, Inc.