Reasons for delayed spinal cord decompression in individuals with traumatic spinal cord injuries in Iran: A qualitative study from the perspective of neurosurgeons

Chinese Journal of Traumatology, 2021 · DOI: https://doi.org/10.1016/j.cjtee.2021.07.001 · Published: July 2, 2021

Spinal Cord Injury Surgery Research Methodology & Design

Simple Explanation

This study explores why spinal cord injury patients in Iran experience delays in receiving decompressive surgery, which should ideally happen within 24 hours of the injury. The research seeks to understand the reasons for these delays from the viewpoint of neurosurgeons working in Iranian hospitals. The study involved interviewing 12 neurosurgeons in Iran to gather their perspectives on the factors contributing to delayed surgical decompression. The neurosurgeons' insights were analyzed to identify common themes and reasons for the delays. The study found that patient-related factors, such as the type of spinal cord injury and the presence of other injuries (polytrauma), are major contributors to surgical delays. Healthcare system issues, like delays in patient transfer and equipment availability, and surgeon-related factors, such as attitudes towards surgery timing, also play a role.

Study Duration

Not specified

Participants

12 Iranian neurosurgeons

Evidence Level

Qualitative study

Key Findings

1
Patient-related factors, including the type of spinal cord injury (complete vs. incomplete) and the presence of polytrauma, are the most frequent reasons for delayed decompressive surgery.
2
Healthcare system-related factors, such as delays in transferring patients to trauma centers and the availability of necessary equipment, also contribute to the delays.
3
Surgeons' attitudes and decision-making processes, where decisions regarding surgical timing are not made based on scientiﬁc evidence but rather considering the surgeon's beneﬁt, contribute to delays.

Research Summary

The study aimed to identify reasons for delayed spinal cord decompression in Iran, where the median time to surgery is 6.9 days, far exceeding recommended guidelines. Qualitative interviews with 12 Iranian neurosurgeons were conducted and analyzed. The results indicated that patient-related factors are the most frequent reasons for delay, specifically the type of injury and presence of polytrauma. Healthcare system-related issues such as delays in patient transfer and equipment availability also contribute. Surgeon-related factors, particularly the surgeons' attitudes towards prioritizing early surgery, also contribute to the delays. The study suggests that addressing these factors through knowledge translation and optimizing medical systems is crucial.

Practical Implications

Improve Patient Transfer Systems

Streamline the transfer of patients with SCI, particularly from rural areas, to specialized trauma centers to reduce delays in accessing care.

Optimize Resource Allocation

Ensure timely availability of necessary surgical equipment and personnel to facilitate prompt decompressive surgery for SCI patients.

Address Surgeon Attitudes

Implement educational programs and feedback mechanisms to promote evidence-based decision-making among surgeons regarding the timing of decompressive surgery.

Study Limitations

1
Lack of generalizability due to the study being conducted only in government-sponsored hospitals.
2
The qualitative design requires validation through subsequent quantitative studies.
3
Small sample size with only 12 participants.

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