Readmission and Associated Factors in Surgical Versus Non-Surgical Management of Spinal Epidural Abscess: A Nationwide Readmissions Database Analysis

Abstract

Study Design: Retrospective cohort study. Objectives: Spinal epidural abscess (SEA) is a rare but potentially life-threatening infection treated with antimicrobials and, in most cases, immediate surgical decompression. Previous studies comparing medical and surgical management of SEA are low powered and limited to a single institution. As such, the present study compares readmission in surgical and non-surgical management using a large national dataset. Methods: We identified all hospital admissions for SEA using the Nationwide Readmissions Database (NRD), which is the largest collection of hospital admissions data. Patients were grouped into surgically and non-surgically managed cohorts using ICD-10 coding and compared using information retrieved from the NRD such as demographics, comorbidities, length of stay and cost of admission. Results: We identified 350 surgically managed and 350 non-surgically managed patients. The 90-day readmission rates for surgical and non-surgical management were 26.0% and 35.1%, respectively ( P < .05). Expectedly, surgical management was associated with a significantly higher charge and length of stay at index hospital admission. Surgically managed patients had a significantly lower risk of readmission for osteomyelitis ( P < .05). Finally, in patients with a low comorbidity burden, we observed a significantly lower 90-day readmission rate for surgically managed patients (surgical: 23.0%, non-surgical: 33.8%, P < .05). Conclusion: In patients with a low comorbidity burden, we observed a significantly lower readmission rate for surgically managed patients than non-surgically managed patients. The results of this study suggest a lower readmission rate as an advantage to surgical management of SEA and emphasize the importance of SEA as a not-to-miss diagnosis.

Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis

“…Definitions of early surgery were heterogeneous, and a list of definitions used can be found in Supplemental Digital Content 1: Supplementary Table S7 . Twenty studies did not provide information on how much time had elapsed between patient admission or diagnosis and when they had surgery 23 – 27 , 30 , 31 , 34 , 35 , 38 , 39 , 41 – 46 , 48 , 50 , 51 . Five studies reported that patients had surgery ‘immediately’ once the diagnosis was made, but did not define this time frame quantitively 29 , 37 , 40 , 49 , 52 .…”

“…3 C[b]) 23 , 42 , 51 . Sixteen studies stated that overall, when taking into account both neurological and clinical outcomes, early surgery yielded better outcomes 13 , 14 , 24 , 26 , 28 , 29 , 32 , 34 , 39 , 40 , 43 , 44 , 48 , 50 – 52 , while 10 studies stated that there was no difference 23 , 25 , 27 , 30 , 31 , 33 , 37 , 41 , 42 , 47 . No study stated that conservative treatment was superior (Fig.…”

Patients Follow-up for Spinal Epidural Abscess as a Critical Treatment Plan Consideration

“…Behmanesh et al showed a 30% readmission rate in non-operatively treated patients (with many of those subsequently going on to surgical intervention) compared to a 4.1% and 6.4% readmission rate in early and late surgically treated patients respectively [14]. Pitaro et al also noted lower readmission rates in surgically treated patients [9]. In another study, 52% of conservatively treated patients were noted to have worsened compared to 8% in the surgically treated group [15].…”

“…Most often, follow-up was reported as a mean and a range, with further details omitted. It was also typically not clearly reported how many patients may have been excluded from the study due to inadequate follow-up [2,4,5,[9][10][11][12][13][14][15][16][17][18][19].…”

“…While many appropriately selected patients can be treated non-operatively, the literature supports aggressively treating abscesses surgically when there is a corresponding clinical concern [9,14,15]. Perhaps, reliable follow-up should also be considered when formulating a treatment plan for patients with SEAs.…”