scholarly journals Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis

2021 ◽  
Vol 10 (22) ◽  
pp. 5451
Author(s):  
Jeong Hwan Lee ◽  
Jihye Kim ◽  
Tae-Hwan Kim
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Older Patients ◽  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
Spinal Instrumentation ◽  
Nonoperative Treatment ◽  
Adverse Outcomes ◽  
Neurologic Deficits ◽  
Pyogenic Vertebral Osteomyelitis

Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.

Efficacy and safety of surgery for spontaneous pneumothorax in elderly patients

2019 ◽  
Author(s):  
Shunichi Nagata ◽  
Mitsugu Omasa ◽  
Kosuke Tokushige ◽  
Takao Nakanishi ◽  
Hideki Motoyama
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Spontaneous Pneumothorax ◽  
Performance Status ◽  
Multivariable Analysis ◽  
Efficacy And Safety ◽  
Air Leaks ◽  
Grade 3

Abstract OBJECTIVES There is no clear consensus on the surgical indications for spontaneous pneumothorax in elderly patients. In this study, we aimed to assess the efficacy and safety of surgical treatment of spontaneous pneumothorax in patients aged ≥70 years. We also sought to identify the risk factors for postoperative prolonged air leaks and complications in such patients. METHODS Data pertaining to 104 elderly patients who underwent surgery out of 206 patients (aged ≥70 years) who were diagnosed with spontaneous pneumothorax at our institution between 1994 and 2018 were retrospectively reviewed. The incidences of postoperative persistent air leaks (≥2 days) and postoperative complications (≥grade 3; Clavien–Dindo classification) were analysed for efficacy and safety assessment, respectively. RESULTS Median postoperative air leaks continued for 0 days (range 0–25); 14.4% patients developed ≥grade 3 postoperative complications. On the basis of results of multivariable analysis, it was observed that a higher PaCO2 level was significantly associated with prolonged postoperative air leaks [odds ratio (OR) 1.08, 95% confidence interval (CI) 1.00–1.17; P = 0.047]. Poorer performance status was associated with a significantly increased risk of postoperative complications, as assessed by multivariable analysis (OR 6.13, 95% CI 1.38–27.3; P = 0.017). The recurrence rate was 4.8%; mortality rate of patients was 2.9%. Three-year survival rate after surgery was 73.8%. CONCLUSIONS Surgical treatment of spontaneous pneumothorax may be effective and safe in selected elderly patients. Moreover, higher PaCO2 and poorer performance status were independent risk factors for postoperative persistent air leaks and complications, respectively.

scholarly journals Characteristics of and risk factors for severe neurological deficit in patients with pyogenic vertebral osteomyelitis

Medicine ◽  
2017 ◽  
Vol 96 (21) ◽  
pp. e6387 ◽  
Author(s):  
Adrien Lemaignen ◽  
Idir Ghout ◽  
Aurélien Dinh ◽  
Guillaume Gras ◽  
Bruno Fantin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Neurological Deficit ◽  
Vertebral Osteomyelitis ◽  
Pyogenic Vertebral Osteomyelitis

Spontaneous pyogenic vertebral osteomyelitis and endocarditis: Incidence, risk factors, and outcome

2005 ◽  
Vol 118 (11) ◽  
pp. 1287.e17-1287.e24 ◽  
Author(s):  
Carlos Pigrau ◽  
Benito Almirante ◽  
Xavier Flores ◽  
Vicenç Falco ◽  
Dolors Rodríguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vertebral Osteomyelitis ◽  
Incidence Risk ◽  
Pyogenic Vertebral Osteomyelitis

NONOPERATIVE MANAGEMENT OF ODONTOID FRACTURES USING A HALOTHORACIC VEST

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 522-530 ◽  
Author(s):  
Patrick Platzer ◽  
Gerhild Thalhammer ◽  
Kambiz Sarahrudi ◽  
Florian Kovar ◽  
Gyoergy Vekszler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Fracture Healing ◽  
Nonoperative Management ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Long Term Results ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Appropriate Treatment

Abstract OBJECTIVE Despite various reports in the literature, the appropriate treatment of Type II odontoid fractures remains controversial. Although there is an increasing tendency toward surgical treatment of these fractures in recent years, nonoperative treatment strategies are still regarded as a practicable method, particularly in elderly patients with significant comorbidities. One purpose of this study was to determine the functional and radiographic long-term results after rigid immobilization of Type II odontoid fractures using a halothoracic vest. The second aim was to present a case-control series of patients with nonunion of Type II odontoid fractures compared with patients with successful fracture healing to determine specific risk factors for failure of halo immobilization. METHODS We reviewed the clinical and radiographic records of 90 patients with an average age of 69 years at the time of injury who had undergone nonoperative treatment of odontoid fractures using a halothoracic vest between 1988 and 2004. To identify potential risk factors for failure of halo fixation, patients were divided into “cases” and “controls.” Cases were defined as patients with nonfusion after halo immobilization, and controls were patients with successful fracture healing attained with this treatment option. RESULTS Seventy-five patients returned to their preinjury activity level and were satisfied with their treatment. The Smiley-Webster scale showed an overall functional outcome score of 1.64. Successful fracture healing was achieved in 76 patients (84%). In 14 patients, nonunion was diagnosed by standard x-rays and additional computed tomographic scans within 6 to 12 months after trauma. Referring to possible risk factors for failure of halo fixation, nonunion was found significantly more often in older patients and in those with displaced fractures of the odontoid. Secondary loss of reduction and delay of treatment were identified as further risk factors for nonfusion. CONCLUSION With regard to successful fracture healing and functional results of the patients, we had a satisfactory outcome after halo fixation of Type II odontoid fractures. Although a fusion rate of 84% should not be deemed as optimal, nonoperative management of these fractures using a halothoracic vest seems to be an appropriate treatment strategy in patients who are not suitable for surgical treatment.

Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis

Infection ◽  
2015 ◽  
Vol 44 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Alba Ribera ◽  
Maria Labori ◽  
Javier Hernández ◽  
Jaime Lora-Tamayo ◽  
Lluís González-Cañas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vertebral Osteomyelitis ◽  
Compressive Fracture ◽  
Pyogenic Vertebral Osteomyelitis

Involvement of L5-S1 level as an independent risk factor for adverse outcomes after surgical treatment of lumbar pyogenic spondylitis: A multivariate analysis

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110355
Author(s):  
Sung Cheol Park ◽  
Sam Yeol Chang ◽  
GeunWu Gimm ◽  
Sujung Mok ◽  
Hyoungmin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Treatment Failure ◽  
Significant Risk ◽  
Binary Logistic Regression ◽  
Adverse Outcomes ◽  
Polymicrobial Infection ◽  
Pyogenic Spondylitis ◽  
Independent Risk Factors ◽  
Thorough Debridement

Purpose: To identify the independent risk factors for adverse outcomes and determine the effect of L5-S1 involvement on the outcome of surgical treatment of lumbar pyogenic spondylitis (PS). Methods: A retrospective analysis was performed for all consecutive patients who underwent surgery for lumbar PS between November 2004 and June 2020 at a single institution. The patients were divided into two groups based on the outcomes: good and adverse (treatment failure, relapse, or death). Treatment failure was defined as persistent or worsening pain with C-reactive protein (CRP) reduction less than 25% from preoperative measurement or requiring additional debridement. Relapse was defined as the reappearance of symptoms and signs with an elevated white blood cell count, erythrocyte sedimentation rate, and CRP after the first period of treatment. Binary logistic regression analyses were performed to identify the independent risk factors for adverse outcomes. Results: Twenty-four (21.2%) of the 113 patients were classified as having adverse outcomes: treatment failure, relapse, and death occurred in 15, 7, and 2 patients, respectively. The involvement of L5-S1 (adjusted odds ratio [aOR] = 6.561, P = 0.004), Methicillin-resistant Staphylococcus aureus (MRSA) infection (aOR = 6.870, P = 0.008), polymicrobial infection (aOR = 12.210, P = 0.022), and Charlson comorbidity index (CCI; P = 0.005) were identified as significant risk factors for adverse outcomes. Conclusion: Involvement of L5-S1, MRSA, polymicrobial infection, and CCI were identified as independent risk factors for adverse outcomes after surgical treatment of lumbar PS. Because L5-S1 is anatomically demanding to access anteriorly, judicious access and thorough debridement are recommended in patients requiring anterior debridement of L5-S1.

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