Complications, Length of Hospital Stay, and Cost of Care after Surgery for Pyogenic Spondylodiscitis

Abstract

Background Infectious Spondylodiscitis is a heterogeneous disease usually affecting a fragile patient population with multiple comorbidities. Therefore, surgical and medical complications are important considerations before initiating treatment.

Methods This retrospective analysis included data of 218 patients who underwent surgical treatment for pyogenic Spondylodiscitis between 2008 and 2016. Groups were divided into length of hospital stay (LOS) (group I ≤21 days and group II>21 days). Analysis included patient age, gender, Charlson comorbidity index, smoking, obesity, osteoporosis, colonization with multidrug-resistant bacteria, preoperative neurologic deficit, pre- and postoperative inflammation markers (CRP and WBC), duration of surgery, number of operated segments, vertebrectomy, and postoperative medical and surgical complications. The case value for each patient expressed in Euro was retrieved from hospital records and included in the analysis.

Results Duration of stay after surgical treatment of Spondylodiscitis was ≤21 days (range: 4–21 days; mean: 16 days) in 41% of patients and >21 days (range: 22–162 days; mean: 41 days) in 59% of the patients. Multivariate analysis showed that both medical complications (odds ratio [OR]: 2.62; 95% confidence interval [CI]: 1.24–5.56; p=0.012) and surgical site infection (OR: 6.04; 95% CI: 2.35–15.51; p<0.001) were independently associated with a long hospital stay. Case values averaged at €21,667±1,579 (minimum: €2,888; maximum: €203,802) and correlated significantly with the length of hospital stay (Pearson's correlation coefficient: 0.681; p<0.05). The occurrence of a postoperative complication increased the cost of care significantly from €17,790 to 24,527 on average (p=0.025).

Conclusions This study provides benchmark data for patients treated surgically for Spondylodiscitis. Surgical site infection and medical complications are the main drivers of prolonged hospital stays and cost of care.

Keywords

Spondylodiscitis - hospital-associated infection - osteomyelitis - spondylitis - epidural abscess

Publication History

Received: 20 December 2021

Accepted: 23 March 2022

Accepted Manuscript online:
30 March 2022

Article published online:
13 September 2022

• References

• 1 Gouliouris T, Aliyu SH, Brown NM. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 2010; 65 (Suppl. 03) iii11-iii24
• 2 Chelsom J, Solberg CO. Vertebral osteomyelitis at a Norwegian university hospital 1987-97: clinical features, laboratory findings and outcome. Scand J Infect Dis 1998; 30 (02) 147-151
• 3 Krogsgaard MR, Wagn P, Bengtsson J. Epidemiology of acute vertebral osteomyelitis in Denmark: 137 cases in Denmark 1978-1982, compared to cases reported to the National Patient Register 1991-1993. Acta Orthop Scand 1998; 69 (05) 513-517
• 4 Beronius M, Bergman B, Andersson R. Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95. Scand J Infect Dis 2001; 33 (07) 527-532
• 5 Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ. et al. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 1997; 56 (12) 709-715
• 6 Hopkinson N, Stevenson J, Benjamin S. A case ascertainment study of septic discitis: clinical, microbiological and radiological features. QJM 2001; 94 (09) 465-470
• 7 Rutges JP, Kempen DH, van Dijk M, Oner FC. Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 2016; 25 (04) 983-999
• 8 Kehrer M, Pedersen C, Jensen TG, Lassen AT. Increasing incidence of pyogenic spondylodiscitis: a 14-year population-based study. J Infect 2014; 68 (04) 313-320
• 9 Cervan AM, Colmenero JdeD, Del Arco A, Villanueva F, Guerado E. Spondylodiscitis in patients under haemodyalisis. Int Orthop 2012; 36 (02) 421-426
• 10 Tsai TT, Yang SC, Niu CC. et al. Early surgery with antibiotics treatment had better clinical outcomes than antibiotics treatment alone in patients with pyogenic spondylodiscitis: a retrospective cohort study. BMC Musculoskelet Disord 2017; 18 (01) 175
• 11 Dragsted C, Aagaard T, Ohrt-Nissen S, Gehrchen M, Dahl B. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis. J Orthop Surg (Hong Kong) 2017; 25 (02) 2309499017716068
• 12 Alaid A, von Eckardstein K, Smoll NR. et al. Robot guidance for percutaneous minimally invasive placement of pedicle screws for pyogenic spondylodiscitis is associated with lower rates of wound breakdown compared to conventional fluoroscopy-guided instrumentation. Neurosurg Rev 2018; 41 (02) 489-496
• 13 Jazini E, Carreon LY, Fleming J. et al. Direct costs for treatment of spine osteomyelitis exceeds the Medicare allowable threshold. Spine J 2017; 17: S143-S4
• 14 Adogwa O, Lilly DT, Khalid S. et al. Extended length of stay after lumbar spine surgery: sick patients, postoperative complications, or practice style differences among hospitals and physicians?. World Neurosurg 2019; 123: e734-e739
• 15 Ridic G, Gleason S, Ridic O. Comparisons of health care systems in the United States, Germany and Canada. Mater Sociomed 2012; 24 (02) 112-120
• 16 Lazennec JY, Fourniols E, Lenoir T. et al; French Spine Surgery Society. Infections in the operated spine: update on risk management and therapeutic strategies. Orthop Traumatol Surg Res 2011; 97 (6, Suppl): S107-S116
• 17 Fichtner J, Hofmann N, Rienmüller A. et al. Revision rate of misplaced pedicle screws of the thoracolumbar spine-comparison of three-dimensional fluoroscopy navigation with freehand placement: a systematic analysis and review of the literature. World Neurosurg 2018; 109: e24-e32
• 18 Valancius K, Hansen ES, Høy K, Helmig P, Niedermann B, Bünger C. Failure modes in conservative and surgical management of infectious spondylodiscitis. Eur Spine J 2013; 22 (08) 1837-1844
• 19 Yin S, Tao H, Du H. et al. Postoperative pulmonary complications following posterior spinal instrumentation and fusion for congenital scoliosis. PLoS One 2018; 13 (11) e0207657
• 20 Segreto FA, Beyer GA, Grieco P. et al. Vertebral osteomyelitis: a comparison of associated outcomes in early versus delayed surgical treatment. Int J Spine Surg 2018; 12 (06) 703-712
• 21 Arrigo RT, Kalanithi P, Cheng I. et al. Charlson score is a robust predictor of 30-day complications following spinal metastasis surgery. Spine 2011; 36 (19) E1274-E1280
• 22 Grossman R, Mukherjee D, Chang DC. et al. Preoperative Charlson comorbidity score predicts postoperative outcomes among older intracranial meningioma patients. World Neurosurg 2011; 75 (02) 279-285
• 23 Bernard L, Dinh A, Ghout I. et al; Duration of Treatment for Spondylodiscitis (DTS) study group. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385 (9971): 875-882
• 24 Berbari EF, Kanj SS, Kowalski TJ. et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis 2015; 61 (06) e26-e46