Study design <p>Pre-specified secondary endpoint analysis from a prospective cohort study.</p> Objectives <p>Evaluate whether early surgical decompression (≤12 h) improves quality of life (QOL) compared to late surgical decompression (&gt;12 h and &lt;14 days) in patients with acute traumatic spinal cord injury (tSCI).</p> Setting <p>European multicentre study.</p> Methods <p>Data were drawn from the Prospective, Observational European Multicentre study on the efficacy of acute surgical decompression after tSCI (SCI-POEM). Patients were grouped by decompression timing. Neurological status was assessed using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). QOL was assessed at 6 and 12 months post-injury using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF).</p> Results <p>The early group (n = 126) had greater baseline neurological impairment than the late group (n = 100). Despite these imbalances, unadjusted analysis showed no significant differences between groups in WHOQOL-BREF domains at one year post-injury (physical: 65.2 vs. 65.6, p = 0.868; psychological: 68.0 vs. 68.6, p = 0.806; social: 69.8 vs. 67.4, p = 0.397; environmental: 75.2 vs. 71.4, p = 0.083). A multivariate mixed model revealed no significant differences in WHOQOL-BREF domains between early and late groups one year post-injury (physical: 65.7 vs. 63.8, p = 1.000; psychological: 68.5 vs. 66.9, p = 1.000; social: 72.8 vs. 68.0, p = 1.000; environmental: 80.1 vs. 74.7, p = 0.209).</p> Conclusions <p>No significant differences in WHOQOL-BREF domain scores were observed between early and late surgical decompression following acute tSCI in both unadjusted and adjusted analyses. QOL outcomes provide improved understanding of therapeutic interventions’ impact on patients’ lives and should be incorporated into evaluations of early decompression efficacy.</p> ClinicalTrials.gov identifier <p>NCT01674764.</p>