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

2021 ◽  
pp. 219256822110391
Author(s):  
Nicholas L. Pitaro ◽  
Justin E. Tang ◽  
Varun Arvind ◽  
Brian H. Cho ◽  
Eric A. Geng ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Surgical Management ◽  
Readmission Rate ◽  
Hospital Admissions ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Comorbidity Burden ◽  
Icd 10 ◽  
Life Threatening ◽  
Spinal Epidural

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.

scholarly journals Spinal Epidural Abcess

2018 ◽  
Vol 21 (1) ◽  
pp. 60-63
Author(s):  
Douglas Serra Vasconcelos ◽  
Lucas Crociati Meguins ◽  
Domingos Edno Castro Ribeiro ◽  
Giselle Da Silva Mello ◽  
Dicla Caroline Hartuique Rodrigues ◽  
...  
Keyword(s):  
Back Pain ◽  
Hospital Admissions ◽  
Epidural Abscess ◽  
Thoracolumbar Spine ◽  
Surgical Decompression ◽  
Spinal Epidural Abscess ◽  
Neurologic Deficits ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is an extremely rare life-threatening infectious disorder. It accounts for 0.2-2.0/10,000 hospital admissions per year. We report on a young man with a recent history of furunculosis that evolved febrile back pain associated with triparesia with right upper extremity paresis and crural paraplegia. He referred also symptoms of urinary incontinency. Magnetic resonance imaging (MRI) of the thoracolumbar spine showed an epidural mass compressing two thoracic vertebras, from T4 to T5. The patient underwenturgent surgical decompression of the epidural abscess and culture of the purulent collection grew Methicillin-sensitive Staphylococcus aureus. Postoperative combined intravenous antibiotic treatment was instituted with metronidazole, oxacilin and gentamicin during 30 days. The patient had anuneventful recovery without any residual neurologic deficits. This report highlights the importance of an early suspicion of SEA in patients with febrile back pain and initial neurologic deficits with known risk factors for epidural abscess. Aggressive treatment with surgical decompression and systemicantibiotics seems to be an appropriate approach to prevent permanent neurologic deficits.

scholarly journals Just the Facts: Risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 753-755
Author(s):  
Zoe Polsky ◽  
Shawn K. Dowling ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Thoracic Spinal ◽  
Life Threatening ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Whole Spine ◽  
Spinal Epidural

A 65-year-old male with a history of hypertension presents to the emergency department (ED) with new onset of non-traumatic back pain. The patient is investigated for life-threatening diagnoses and screened for “red flag symptoms,” including fever, neurologic abnormalities, bowel/bladder symptoms, and a history of injectiondrug use (IVDU). The patient is treated symptomatically and discharged home but represents to the ED three additional times, each time with new and progressive symptoms. At the time of admission, he is unable to ambulate, has perineal anesthesia, and 500 cc of urinary retention. Whole spine magnetic resonance imaging (MRI) confirms a thoracic spinal epidural abscess. This case, and many like it, prompts the questions: when should emergency physicians consider the diagnosis of a spinal epidural abscess, and what is the appropriate evaluation of these patients in the ED? (Figure 1).

Brain Abscess and Spinal Epidural Abscess

2019 ◽  
pp. 642-648
Author(s):  
Selby G. Chen
Keyword(s):  
Magnetic Resonance Imaging ◽  
Brain Abscess ◽  
Hospital Admissions ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Early Management ◽  
Brain Abscesses ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Epidural ◽  
The Brain

Two infections of the brain are relatively common. Patients with brain abscess are often critically ill and have a high mortality rate. The reported incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000 people. In contrast, spinal epidural abscess (SEA), an infection of the epidural space, has increased in incidence from approximately 0.2 to 1.2 per 10,000 hospital admissions in the mid-1970s to a currently estimated 2.0 to 12.5 per 10,000 admissions. Both disorders are now more easily detected with magnetic resonance imaging (MRI), and this has improved early management, but clinical recognition is still a challenge for many physicians.

Medical vs Surgical Management of Spinal Epidural Abscess

2004 ◽  
Vol 164 (22) ◽  
pp. 2409 ◽  
Author(s):  
Farhan Siddiq ◽  
Ashish Chowfin ◽  
Robert Tight ◽  
Abe E. Sahmoun ◽  
Raymond A. Smego
Keyword(s):  
Surgical Management ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Spinal Epidural

Medical and surgical management of spinal epidural abscess: a systematic review

2014 ◽  
Vol 37 (2) ◽  
pp. E4 ◽  
Author(s):  
Leopold Arko ◽  
Eric Quach ◽  
Vincent Nguyen ◽  
Daniel Chang ◽  
Vishad Sukul ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Management ◽  
Medical Therapy ◽  
Medical Management ◽  
Epidural Abscess ◽  
Nonoperative Treatment ◽  
Spinal Epidural Abscess ◽  
Nonsurgical Management ◽  
Significant Difference ◽  
Spinal Epidural

Object Spinal epidural abscess (SEA) is a rare condition that has previously been treated with urgent surgical decompression and antibiotics. Recent availability of MRI makes early diagnosis possible and allows for the nonoperative treatment of SEA in select patients. The first retrospective review of medically and surgically managed SEA was published in 1999, and since that time several other retrospective institutional reports have been published. This study reviews these published reports and compares pooled data with historical treatment data. Methods A PubMed keyword and Boolean search using (“spinal epidural abscess” OR “spinal epidural abscesses” AND [management OR treatment]) returned 429 results. Filters for the English language and publications after 1999 were applied, as the first study comparing operative and nonoperative management was published that year. Articles comparing operative to nonoperative treatment strategies for SEA were identified, and the references were further reviewed for additional articles. Studies involving at least 10 adult patients (older than 18 years) were included. Case reports, studies reporting either medical or surgical management only, studies not reporting indications for conservative management, or studies examining SEA as a result of a specific pathogen were excluded. Results Twelve articles directly comparing surgical to nonsurgical management of SEA were obtained. These articles reported on a total of 1099 patients. The average age of treated patients was 57.24 years, and 62.5% of treated patients were male. The most common pathogens found in blood and wound cultures were Staphylococcus aureus (63.6%) and Streptococcus species (6.8%). The initial treatment was surgery in 59.7% of cases and medical therapy in 40.3%. This represented a significant increase in the proportion of medically managed patients in comparison with the historical control prior to 1999 (p < 0.05). Patients with no neurological deficits were significantly more likely to be treated medically than surgically (p < 0.05). There was no statistically significant difference overall between surgical and nonsurgical management, although several risk factors may predict failure of medical management. Conclusions . Since the first reports of nonoperative treatment of SEA, there has been a substantial trend toward treating neurologically intact patients with medical management. Nevertheless, medical therapy fails in a fair number of cases involving patients with specific risk factors, and patients with these risk factors should be closely observed in consideration for surgery. Further research may help identify patients at greater risk for failure of medical therapy.

Emergent Surgical Management of Patients with Sepsis and Neurologic Deterioration Due to a Spinal Epidural Abscess

2014 ◽  
Vol 14 (11) ◽  
pp. S69-S70 ◽  
Author(s):  
Christopher G. Furey ◽  
Katherine Sadowski ◽  
Jon Belding ◽  
Nicholas U. Ahn
Keyword(s):  
Surgical Management ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Neurologic Deterioration ◽  
Spinal Epidural

scholarly journals The Prognostic Accuracy of Suggested Predictors of Failure of Medical Management in Patients With Nontuberculous Spinal Epidural Abscess

2017 ◽  
Vol 8 (3) ◽  
pp. 279-285 ◽  
Author(s):  
Alexandra Stratton ◽  
Peter Faris ◽  
Kenneth Thomas
Keyword(s):  
Medical Management ◽  
Prediction Models ◽  
Epidural Abscess ◽  
Care Center ◽  
Tertiary Care ◽  
White Blood Cells ◽  
Spinal Epidural Abscess ◽  
Icd 10 ◽  
Spinal Epidural ◽  
Prediction Criteria

Study Design: Retrospective cohort study. Objectives: To test the external validity of the 2 published prediction criteria for failure of medical management in patients with spinal epidural abscess (SEA). Methods: Patients with SEA over a 10-year period at a tertiary care center were identified using ICD-10 (International Classification of Diseases, 10th Revision) diagnostic codes; electronic and paper charts were reviewed. The incidence of SEA and the proportion of patients with SEA that were treated medically were calculated. The rate of failure of medical management was determined. The published prediction models were applied to our data to determine how predictive they were of failure in our cohort. Results: A total of 550 patients were identified using ICD-10 codes, 160 of whom had a magnetic resonance imaging–confirmed diagnosis of SEA. The incidence of SEA was 16 patients per year. Seventy-five patients were found to be intentionally managed medically and were included in the analysis. Thirteen of these 75 patients failed medical management (17%). Based on the published prediction criteria, 26% (Kim et al) and 45% (Patel et al) of our patients were expected to fail. Conclusions: Published prediction models for failure of medical management of SEA were not valid in our cohort. However, once calibrated to our cohort, Patel’s model consisting of positive blood culture, presence of diabetes, white blood cells >12.5, and C-reactive protein >115 was the better model for our data.

scholarly journals MRSA Spinal Epidural Abscess as a Neurosurgical and Infectious Disease Emergency with Unresolved Antimicrobial Solution

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
James Ebot ◽  
W. D. Freeman ◽  
Robert Wharen ◽  
Mark Anthony Diaz ◽  
Claudia Libertin
Keyword(s):  
Epidural Abscess ◽  
Dual Therapy ◽  
Blood Cultures ◽  
Spinal Epidural Abscess ◽  
Academic Center ◽  
Life Threatening ◽  
Mrsa Infection ◽  
Potential Damage ◽  
Patient’S Outcome ◽  
Spinal Epidural

Spinal epidural abscess caused by MRSA, a life-threatening organism resistant to methicillin and other antibiotics, is a rare but important infectious pathology due to its potential damage to the spinal cord. We present the case of a 74-year-old man who hematogenously seeded his entire epidural spinal canal from C1 to sacrum with MRSA bacteria and remained infected even after maximal treatment with vancomycin and daptomycin. Ceftaroline, a new 5th generation antibiotic with recently described clearance of widespread MRSA infection in epidural complex spine infections, was added to vancomycin as dual therapy for his MRSA infection. A 74-year-old diabetic man with prior right total knee arthroplasty and MRSA infection presented with persistent bacteremia and sepsis. He was transferred to our academic center after diagnosis of entire spine epidural abscesses from C1 to sacral levels with midthoracic MRI T2 hyperintensities of the vertebral bodies and disc concerning for osteomyelitis and discitis. Despite surgery and IV vancomycin with MIC of 1, suggesting extreme susceptibility, the patient’s blood cultures remained persistently bacteremic at day 5 of treatment. After 48 hours of dual antibiotic therapy with vancomycin and ceftaroline, his blood cultures came back showing no growth. The patient’s outcome was unfavorable due to the advanced nature of his infection and multiple comorbidities, but his negative blood cultures after the addition of ceftaroline to his regime require further investigation into this dual therapy. Randomized controlled trials of 5th generation or combinatorial antibiotics should be considered for this disease.

scholarly journals A rare case as different cause of retropharyngeal and spinal epidural abscess: spondylodiscitis

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Nurlan İsayev ◽  
Levent Yücel ◽  
Hatice Seçil Akyıldız ◽  
Orkhan Mammadkhanlı ◽  
Hazan Başak ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Neurological Deficits ◽  
Retropharyngeal Abscess ◽  
Spinal Epidural Abscess ◽  
Case Presentation ◽  
Life Threatening ◽  
Cervical Magnetic Resonance Imaging ◽  
Spinal Epidural ◽  
Dangerous Condition ◽  
Disease Specialist

Abstract Background Retropharyngeal abscess (RPA) is a life-threatening, dangerous condition and uncommon in adults. The coexistence of RPA, cervical spinal epidural abscess (CSEA), and spondylodiscitis is extremely rare. Case presentation We present a case with a retropharyngeal and epidural abscess caused by spondylodiscitis. A 61-year-old man was referred to our clinic with the complaints of sore throat, limitation in neck range of motion, numbness, and weakness in the left arm and the left ear for one month. The airway was not obstructed. Neurological deficits were detected in his left arm. Cervical computed tomography revealed a 50 × 30 × 15 mm retropharyngeal abscess. Cervical magnetic resonance imaging showed abscess, C5–6 spondylodiscitis and epidural abscess, and myelopathic signal changes in the C3–7 spinal cord. The abscess was drained, and C5–6 discectomy was performed. The patient was discharged with cervical collar and antibiotics. Conclusions Multidisciplinary approach that consists of otolaryngologist, neurosurgeon, and infectious disease specialist is needed to avoid complications and any delay.

Sign in / Sign up

Export Citation Format

Share Document