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

Nicholas L. Pitaro, Justin E. Tang, Varun Arvind, Brian H. Cho, Eric A. Geng, Uchechukwu O. Amakiri, Samuel K. Cho, Jun S. Kim

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

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.

Original languageEnglish
Pages (from-to)1533-1540
Number of pages8
JournalGlobal Spine Journal
Volume13
Issue number6
DOIs
StatePublished - Jul 2023

Keywords

  • NRD
  • SEA
  • comorbidity
  • epidural abscess
  • nationwide
  • readmission
  • readmissions database
  • spinal abscess
  • spinal decompression
  • spine infection

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