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Management of severe pyogenic spinal infections: the 2SICK study by the EANS spine section
A. Kramer, SG. Thavarajasingam, J. Neuhoff, F. Lange, HS. Ponniah, S. Lener, C. Thomé, FC. Stengel, G. Fischer, IC. Hostettler, MN. Stienen, M. Jemna, K. Gousias, A. Nedeljkovic, D. Grujicic, Z. Nedeljkovic, J. Poluga, RT. Schär, W. Urbanski, C....
Language English Country United States
Document type Journal Article, Multicenter Study
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Length of Stay MeSH
- Discitis * therapy mortality surgery microbiology MeSH
- Conservative Treatment MeSH
- Critical Illness MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
BACKGROUND CONTEXT: Spondylodiscitis management presents significant clinical challenges, particularly in critically ill patients, where the risks and benefits of surgical intervention must be carefully balanced. The optimal timing of surgery in this context remains a subject of debate. PURPOSE: This study aims to evaluate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo pyogenic spondylodiscitis. STUDY DESIGN/SETTING: This is an international, multicenter retrospective cohort study involving 24 centers, primarily in Europe. PATIENT SAMPLE: The study included 192 critically ill patients (65.63% male) with a median age of 69 years, all severely affected by pyogenic spondylodiscitis characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. OUTCOME MEASURES: The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates of spondylodiscitis. METHODS: Patients were divided into three groups: early surgery (within three days of admission), delayed surgery (after three days of admission), and conservative therapy. Propensity score matching and multivariate regression analyses were performed to adjust for baseline differences and assess the impact of treatment modalities on mortality and other clinical outcomes. RESULTS: Delayed surgery was associated with significantly lower 30-day mortality (4.05%) compared to early surgery (27.85%) and conservative therapy (27.78%) (p<.001). Delayed surgery also resulted in shorter hospital stays (42.76 days) compared to conservative therapy (55.53 days) and early surgery (26.33 days) (p<.001), and shorter ICU stays (4.52 days) compared to conservative therapy (16.48 days) and early surgery (7.92 days) (p<.001). The optimal window for surgery, minimizing mortality, was identified as ten to fourteen days postadmission (p=.02). Risk factors for increased mortality included age (p<.05), multiple organ failure (p<.05), and vertebral body destruction (p<.05), whereas delayed surgery (p<.05) and the presence of an epidural abscess were associated with reduced mortality (p<.05). CONCLUSIONS: Delayed surgery, optimally between 10 to 14 days postadmission, was associated with lower mortality in critically ill spondylodiscitis patients. These findings highlight the potential benefits of considering surgical timing to improve patient outcomes.
Clinic for Infectious and Tropical Diseases University Clinical Center of Serbia Belgrade Serbia
Clinic for Neurosurgery University Clinical Center of Serbia Belgrade Serbia
Department of Neurosurgery Bethel Clinic University of Bielefeld Medical Center Bielefeld Germany
Department of Neurosurgery Cairo University Medical School and Teaching Hospitals Cairo Egypt
Department of Neurosurgery Christian Doppler Clinic Paracelsus Medical University Salzburg Austria
Department of Neurosurgery Clinical Center University of Sarajevo Sarajevo Bosnia and Herzegovina
Department of Neurosurgery Inselspital Bern University Hospital University of Bern Bern Switzerland
Department of Neurosurgery Jessa Hospital Hasselt Belgium
Department of Neurosurgery Medical University Innsbruck Innsbruck Austria
Department of Neurosurgery Royal Infirmary Edinburgh NHS Lothian Edinburgh United Kingdom
Department of Neurosurgery St Marien Hospital Lünen Germany
Department of Neurosurgery University Hospital of Lausitz Cottbus Germany
Department of Neurosurgery University Hospital Regensburg Regensburg Germany
Department of Neurosurgery University Hospital St Poelten St Polten Austria
Department of Neurosurgery University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Neurosurgery University Medical Center Mainz Mainz Germany
Department of Neurosurgery Wroclaw University Hospital Wroclaw Poland
Division of Neurological Surgery Lagos State University Teaching Hospital Ikeja Lagos State Nigeria
Imperial Brain and Spine Initiative Imperial College London London United Kingdom
Neurosurgery Division Department of Neuroscience Cesena Italy
Neurosurgery Hospital Garcia de Orta Almada Portugal
Neurosurgery Unit Azienda Ospedaliera dei Colli Naples Italy
Neurosurgery Unit Department of Neuroscience University of Turin Turin Italy
References provided by Crossref.org
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- $a Kramer, Andreas $u Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany. Electronic address: andreas.kramer@unimedizin-mainz.de
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