30-day Mortality Following Surgery for Spinal Epidural Abscess: Incidence, Risk Factors, Predictive Algorithm, and Associated Complications

Retrospective case-control study. To determine incidence and timing of mortality following surgery for spinal epidural abscess (SEA), identify risk factors for mortality, and identify complications associated with mortality. SEA is a serious condition with potentially devastating sequelae. There is...

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Veröffentlicht in:Spine (Philadelphia, Pa. 1976) Jg. 44; H. 8; S. E500
Hauptverfasser: Du, Jerry Y, Schell, Adam J, Kim, Chang-Yeon, Trivedi, Nikunj N, Ahn, Uri M, Ahn, Nicholas U
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 15.04.2019
Schlagworte:
Adult
Age Factors
Aged
Algorithms
Case-Control Studies
Comorbidity
Diabetes Mellitus - epidemiology
Epidural Abscess - mortality
Epidural Abscess - surgery
Female
Heart Arrest - mortality
Humans
Incidence
Kidney Diseases - epidemiology
Male
Middle Aged
Pneumonia - mortality
Postoperative Complications - epidemiology
Respiratory Tract Diseases - epidemiology
Retrospective Studies
Risk Factors
ROC Curve
Sepsis - mortality
ISSN:1528-1159, 1528-1159
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Zusammenfassung:Retrospective case-control study. To determine incidence and timing of mortality following surgery for spinal epidural abscess (SEA), identify risk factors for mortality, and identify complications associated with mortality. SEA is a serious condition with potentially devastating sequelae. There is a paucity of literature characterizing mortality following surgery for SEA. The National Surgical Quality Improvement Program (NSQIP) database was used. Patients with a diagnosis of SEA were included. A Cox proportional hazards model identified independent risk factors for 30-day mortality. A predictive model for mortality was created. Multivariate models identified postoperative complications associated with mortality. There were 1094 patients included, with 40 cases of mortality (3.7%), the majority of which occurred within 2 weeks postoperatively (70%). Independent risk factors for 30-day mortality were age>60 years (hazard ratio [HR]: 2.147, P = 0.027), diabetes (HR: 2.242, P = 0.015), respiratory comorbidities (HR: 2.416, P = 0.037), renal comorbidities (HR: 2.556, P = 0.022), disseminated cancer (HR: 5.219, P = 0.001), and preoperative thrombocytopenia (HR: 3.276, P = 0.001). A predictive algorithm predicts a 0.3% mortality for zero risk factors up to 37.5% for 4 or more risk factors. A ROC area under curve (AUC) was 0.761, signifying a fair predictor (95% CI: 0.683-0.839, P < 0.001). Cardiac arrest (adjusted odds ratio [aOR]: 72.240, 95% confidence interval [CI]: 27.8-187.721, P < 0.001), septic shock (aOR: 15.382, 95% CI: 7.604-31.115, P < 0.001), and pneumonia (aOR: 2.84, 95% CI: 1.109-7.275, P = 0.03) were independently associated with mortality. The 30-day mortality rate following surgery for SEA was 3.7%. Of the mortalities that occurred within 30 days of surgery, the majority occurred within 2 weeks. Independent risk factors for mortality included older age, diabetes, hypertension, respiratory comorbidities, renal comorbidities, metastatic cancer, and thrombocytopenia. Risk for mortality ranged from 0.3% to 37.5% based on number of risk factors. Septic shock, cardiac arrest, and pneumonia were associated with mortality. 3.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1528-1159
1528-1159
DOI:10.1097/BRS.0000000000002875