Article
Pyogenic spondylodiscitis – predictors of hospital stay
Prediktoren der prolongierten Aufenthaltsdauer bei Patienten mit pyogenerSpondylodiszitis
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Published: | May 8, 2019 |
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Outline
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Objective: Pygenic spondylodiscitis is a heterogenous disease affecting a fragile patient population with multiple comorbidities. Therefore, hospital stay and surgical complications are important considerations before initiating treatment.
Methods: We reviewed data of 232 patients who underwent surgical treatment for pyogenic spondylodiscitis at our institution between 2008 and 2016. The primary outcome measure was a duration of stay of >21 days (Group I 21 days). Analysis included patient age, gender, Charlson Comorbidity Index, smoking, obesity, osteoporosis, colonization with multidrug-resistant bacteria, preoperative neurological deficit, pre- und postoperative inflammation marker (CRP and WBC), duration of surgery, number of operated segments, vertebrectomy, postoperative complications (pulmonary cardiac and renal complications, as well as infection elsewhere) and surgical site infection.
Results: Duration of stay after surgical treatment of spondylodiscitis was =21 days (22 to 162, mean 41 days) in 60% of the patients. No difference between the two groups was found regarding patient age, gender, Charlson Comorbidity Index and preoperative inflammation markers. Patients with multidrug-resistant bacteria und those who underwent vertebrectomy had a longer hospital stay (OR 3.92, 5–95% CI 1.02–15.03 and p=0.047, OR 2.98, 5–95% CI 1.29–6.92 and p=0.011, respectively). Postoperative complications and surgical site infection were independently associated with a longer duration of hospital stay (OR 3.06, 5–95% CI 1.55–6.03 and p=0.001, OR 7.32, 5–95% CI 2.01–26.61 and p=0.003, respectively).
Conclusion: Patients undergoing surgical treatment for spondylodiscitis are at higher risk of prolonged hospital stay in case of multidrug-resistant bacteria, following vertebrectomy and surgical site infection. Improved postoperative care and wound management must be applied to minimize surgery-related complications.