Highlights
- •Operative intervention was associated with lower 30-day mortality and 1-year mortality compared to conservative treatment.
- •Increased mFI was associated with higher short-term mortality.
- •mFI > 3 trended higher mortality regardless of intervention.
Abstract
Purpose
Investigate outcomes in a spondylodiscitis (SD) patient cohort undergoing operative
and medical treatment or medical treatment alone, accounting for frailty status at
presentation.
Methods
Patients >18 years old undergoing treatment for SD were retrospectively analyzed.
The diagnosis of SD was made through a combination of clinical findings, MRI/CT findings,
and blood/tissue cultures. Those who failed to respond to antibiotics, had deteriorating
markers, or developed neurologic compromise were considered operative candidates.
Patients were stratified based on operative (Op, operative plus medical management)
or conservative (Cons, medical only) treatment. Univariate analyses identified differences
in outcome measures across treatment groups. Conditional forward regression equations,
controlling for patient age, identified predictors of increased mortality and inferior
outcomes.
Results
116 patients with SD were included. 73 underwent Cons treatment and 43 were Op. Op
patients were significantly younger (62.9vs70.7yrs; p < 0.001) and less frail (1.09vs1.85;
p < 0.006) than Cons patients, with significantly higher WCC and ESR. Cons pts had
higher rates of isolated SD, but Op pts had higher rates of SD with associated SEA,
VOM, psoas abscess, and para-vertebral abscess (all p < 0.05). Op pts had significantly
lower 30-day mortality than Cons pts (2.3%vs17.8%, p = 0.016), and trended lower 1Y
mortality (11.6%vs20.5%, p = 0.310) with similar SD recurrence rates (11.6%vs16.4%,
p = 0.592). Patients with an mFI > 3 had significantly higher 30-day mortality (30.4%
vs 7.5%, p = 0.003) and trended higher 1-year mortality regardless of intervention.
Conclusions
Operative intervention was associated with lower 30-day mortality significantly and
1-year mortality compared to conservative treatment, while an increased mFI was associated
with higher short-term mortality.
Keywords
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Article info
Publication history
Published online: March 12, 2020
Accepted:
March 2,
2020
Received:
October 22,
2019
Identification
Copyright
© 2020 Published by Elsevier Ltd.
