Advertisement

Predictors of reoperation after surgery for spinal epidural abscess

      Abstract

      BACKGROUND CONTEXT

      Spinal epidural abscess is a rare but severe condition with high rates of postoperative adverse events.

      PURPOSE

      The objective of the study was to identify independent prognostic factors for reoperation using two datasets: an institutional and national database.

      STUDY DESIGN/SETTING

      Retrospective Review.

      PATIENT SAMPLE

      Database 1: Review of five medical centers from 1993 to 2016. Database 2: The National Surgical Quality Improvement Program (NSQIP) was queried between 2012 and 2016.

      OUTCOME MEASURES

      Thirty-day and ninety-day reoperation rate.

      METHODS

      Two independent datasets were reviewed to identify patients with spinal epidural abscesses undergoing spinal surgery. Multivariate analyses were used to determine independent prognostic factors for reoperation while including factors identified in bivariate analyses.

      RESULTS

      Overall, 642 patients underwent surgery for a spinal epidural abscess in the institutional cohort, with a 90-day unplanned reoperation rate of 19.9%. In the NSQIP database, 951 patients were identified with a 30-day unplanned reoperation rate of 12.3%. On multivariate analysis in the NSQIP database, cervical spine abscess was the only factor that reached significance for 30-day reoperation (OR=1.71, 95% CI=1.11–2.63, p=.02, Area under the curve (AUC)=0.61). On multivariate analysis in the institutional cohort, independent prognostic factors for 30-day reoperation were: preoperative urinary incontinence, ventral location of abscess relative to thecal sac, cervical abscess, preoperative wound infection, and leukocytosis (AUC=0.65). Ninety-day reoperation rate also found hypoalbuminemia as a significant predictor (AUC=0.66).

      CONCLUSION

      Six novel independent prognostic factors were identified for 90-day reoperation after surgery for a spinal epidural abscess. The multivariable analysis fairly predicts reoperation, indicating that there may be additional factors that need to be uncovered in future studies. The risk factors delineated in this study through the use of two large cohorts of spinal epidural abscess patients can be used to improve preoperative risk stratification and patient management.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Spine Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ameer MA
        • Knorr TL
        • Mesfin FB
        Spinal epidural abscess.
        StatPearls Publishing, Treasure IslandFL2021 (StatPearls)
        • Schwab JH
        • Shah AA.
        Spinal epidural abscess: diagnosis, management, and outcomes.
        J Am Acad Orthop Surg. 2020; 28: e929-e938https://doi.org/10.5435/JAAOS-D-19-00685
        • Epstein NE.
        Timing and prognosis of surgery for spinal epidural abscess: a review.
        Surg Neurol Int. 2015; 6: S475-S486https://doi.org/10.4103/2152-7806.166887
        • Ma H
        • Kim I.
        Clinical outcomes of spinal epidural abscess.
        Korean J Spine. 2012; 9: 6-11https://doi.org/10.14245/kjs.2012.9.1.6
        • Schoenfeld AJ
        • Wahlquist TC.
        Mortality, complication risk, and total charges after the treatment of epidural abscess.
        Spine J. 2015; 15: 249-255https://doi.org/10.1016/j.spinee.2014.09.003
        • Du JY
        • Schell AJ
        • Kim C-Y
        • Trivedi NN
        • Ahn UM
        • Ahn NU.
        30-day mortality following surgery for spinal epidural abscess: incidence, risk factors, predictive algorithm, and associated complications.
        Spine (Phila Pa 1976). 2019; 44: E500-E509https://doi.org/10.1097/BRS.0000000000002875
        • Patel AR
        • Alton TB
        • Bransford RJ
        • Lee MJ
        • Bellabarba CB
        • Chapman JR.
        Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases.
        Spine J. 2014; 14: 326-330https://doi.org/10.1016/j.spinee.2013.10.046
        • Shah AA
        • Ogink PT
        • Nelson SB
        • Harris MB
        • Schwab JH.
        Nonoperative management of spinal epidural abscess: development of a predictive algorithm for failure.
        J Bone Joint Surg Am. 2018; 100: 546-555https://doi.org/10.2106/JBJS.17.00629
        • Alton TB
        • Patel AR
        • Bransford RJ
        • Bellabarba C
        • Lee MJ
        • Chapman JR.
        Is there a difference in neurologic outcome in medical versus early operative management of cervical epidural abscesses?.
        Spine J. 2015; 15: 10-17https://doi.org/10.1016/j.spinee.2014.06.010
        • Karhade AV
        • Shah AA
        • Bono CM
        • Ferrone ML
        • Nelson SB
        • Schoenfeld AJ
        • et al.
        Development of machine learning algorithms for prediction of mortality in spinal epidural abscess.
        Spine J. 2019; 19: 1950-1959https://doi.org/10.1016/j.spinee.2019.06.024
        • Du JY
        • Schell AJ
        • Kim C-Y
        • Trivedi NN
        • Ahn UM
        • Ahn NU.
        30-day mortality following surgery for spinal epidural abscess: incidence, risk factors, predictive algorithm, and associated complications.
        Spine (Phila Pa 1976). 2019; 44: E500-E509https://doi.org/10.1097/BRS.0000000000002875
        • Shah AA
        • Ogink PT
        • Harris MB
        • Schwab JH.
        Development of predictive algorithms for pre-treatment motor deficit and 90-day mortality in spinal epidural abscess.
        J Bone Joint Surg Am. 2018; 100: 1030-1038https://doi.org/10.2106/JBJS.17.00630
        • Collins GS
        • Reitsma JB
        • Altman DG
        • Moons KG.
        Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD Statement.
        BMC Med. 2015; 13: 1https://doi.org/10.1186/s12916-014-0241-z
        • von Elm E
        • Altman DG
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP
        Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        BMJ. 2007; 335: 806-808https://doi.org/10.1136/bmj.39335.541782.AD
        • Karhade AV
        • Larsen AMG
        • Cote DJ
        • Dubois HM
        • Smith TR.
        National databases for neurosurgical outcomes research: options, strengths, and limitations.
        Neurosurgery. 2018; 83: 333-344https://doi.org/10.1093/neuros/nyx408
        • Connor DE
        • Chittiboina P
        • Caldito G
        • Nanda A.
        Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome.
        J Neurosurg Spine. 2013; 19: 119-127https://doi.org/10.3171/2013.3.SPINE12762
        • Ghobrial GM
        • Beygi S
        • Viereck MJ
        • Maulucci CM
        • Sharan A
        • Heller J
        • et al.
        Timing in the surgical evacuation of spinal epidural abscesses.
        Neurosurg Focus. 2014; 37: E1https://doi.org/10.3171/2014.6.FOCUS14120
        • Chaker AN
        • Bhimani AD
        • Esfahani DR
        • Rosinski CL
        • Geever BW
        • Patel AS
        • et al.
        Epidural abscess: a propensity analysis of surgical treatment strategies.
        Spine (Phila Pa 1976). 2018; 43: E1479-E1485https://doi.org/10.1097/BRS.0000000000002747
        • Bydon M
        • De la Garza-Ramos R
        • Macki M
        • Naumann M
        • Sciubba DM
        • Wolinsky J-P
        • et al.
        Spinal instrumentation in patients with primary spinal infections does not lead to greater recurrent infection rates: an analysis of 118 cases.
        World Neurosurg. 2014; 82: e807-e814https://doi.org/10.1016/j.wneu.2014.06.014
        • Carragee E
        • Iezza A.
        Does Acute placement of instrumentation in the treatment of vertebral osteomyelitis predispose to recurrent infection: long-term follow-up in immune-suppressed patients.
        Spine (Phila Pa 1976). 2008; 33: 2089-2093https://doi.org/10.1097/BRS.0b013 e3181839b9c
        • Dennis Hey HW
        • Nathaniel NG.LW
        • Tan CS
        • Fisher D
        • Vasudevan A
        • Liu K-PG
        • et al.
        Spinal implants can be inserted in patients with deep spine infection: results from a large cohort study.
        Spine (Phila Pa 1976). 2017; 42: E490-E495https://doi.org/10.1097/BRS.0000000000 001747
        • Bagley CA
        • Dudukovich KJ
        • Wolinsky J-P
        • Gokaslan ZL.
        Surgical management of lumbosacral spinal epidural abscesses.
        Oper TechNeurosurg. 2004; 7: 206-211https://doi.org/10.1053/j.otns.2005.06. 006
        • Turner A
        • Zhao L
        • Gauthier P
        • Chen S
        • Roffey DM
        • Wai EK.
        Management of cervical spine epidural abscess: a systematic review.
        Ther Adv Infect. 2019; 62049936119863940https://doi.org/10.1177/2049 936119863940
        • Karikari I.O.
        • Metz L.N.
        Preventing pseudoarthrosis and proximal junctional kyphosis: how to deal with the osteoporotic spine.
        Neurosurg Clin N Am. 2018; 29: 365-374https://doi.org/10.1016/j.nec.2018. 03.005
        • Soehle M
        • Wallenfang T.
        Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes.
        Neurosurgery. 2002; 51 (discussion 86-87): 79-85https://doi.org/10.1097/00006123-200207000-00013
        • Pradilla G
        • Nagahama Y
        • Spivak AM
        • Bydon A
        • Rigamonti D.
        Spinal epidural abscess: current diagnosis and management.
        Curr Infect Dis Rep. 2010; 12: 484-491https://doi.org/10.1007/s11908-010-0140-1
        • Patel AR
        • Alton TB
        • Bransford RJ
        • Lee MJ
        • Bellabarba CB
        • Chapman JR.
        Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases.
        Spine J. 2014; 14: 326-330https://doi.org/10.1016/j.spinee.2013.10.046
        • Soeters PB
        • Wolfe RR
        • Shenkin A.
        Hypoalbuminemia: pathogenesis and clinical significance.
        J Parenter Enteral Nutr. 2019; 43: 181-193https://doi.org/10.1002/jpen.1451
        • Berbudi A
        • Rahmadika N
        • Tjahjadi AI
        • Ruslami R.
        Type 2 diabetes and its impact on the immune system.
        Curr Diabetes Rev. 2020; 16: 442-449https://doi.org/10.2174/1573399815666191024085 838
        • Ved N
        • Da Vitoria Lobo ME
        • Bestall SM
        • L Vidueira C
        • Beazley-Long N
        • Ballmer-Hofer K
        • et al.
        Diabetes-induced microvascular complications at the level of the spinal cord: a contributing factor in diabetic neuropathic pain.
        J Physiol. 2018; 596: 3675-3693https://doi.org/10.1113/JP275067
        • Karhade AV
        • Shah KC
        • Shah AA
        • Ogink PT
        • Nelson SB
        • Schwab JH
        Neutrophil to lymphocyte ratio and mortality in spinal epidural abscess.
        Spine J. 2019; 19: 1180-1185https://doi.org/10.1016/j.spinee. 2019.02.005