Level I Trauma Centers Are Associated With Lower Adjusted In-Hospital Mortality After Operative Spine Trauma: Analysis of the 2023 United States National Trauma Data Bank

Study Design Retrospective cohort study. Objective To compare in-hospital mortality, complications, and resource utilization among patients undergoing fusion, decompression/discectomy, or instrumentation for spine trauma at Level I vs Level II trauma centers. Methods The National Trauma Data Bank was queried for adult patients with isolated spine trauma who underwent fusion, decompression/discectomy, or instrumentation at a Level I or Level II center. Multivariable logistic and linear regression models were used to adjust for patient demographics, injury severity, comorbidities, and hospital characteristics, comparing in-hospital mortality, complications, and length of stay (LOS). Results We identified 10 295 patients (6588 at Level I; 3707 at Level II). Level I patients were younger, had more severe spinal injuries, and had a higher incidence of spinal cord injury, particularly involving the cervical spine. Unadjusted outcomes showed similar mortality, but longer hospital and ICU LOS at Level I centers. After risk adjustment, treatment at a Level I center was associated with a 34% lower adjusted odds of in-hospital mortality (OR 0.66; 95% CI 0.46-0.96; P = .030). There were no significant differences in adjusted odds of any in-hospital complication or in adjusted hospital and ICU LOS. Conclusion Treatment at a Level I trauma center was associated with a significant survival benefit for patients undergoing operative management for spinal trauma. This mortality advantage was achieved without increasing complications or LOS. Given the retrospective design, causality cannot be inferred. Nevertheless, these findings suggest that Level I centers are associated with a distinct survival advantage for this high-acuity patient population.