Longo Michael, Pennington Zach, Gelfand Yaroslav, De la Garza Ramos Rafael, Echt Murray, Ahmed A Karim, Yanamadala Vijay, Sciubba Daniel M, Yassari Reza
1Spine Research Group and.
2Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and.
J Neurosurg Spine. 2019 Nov 22;32(3):465-472. doi: 10.3171/2019.8.SPINE19790. Print 2020 Mar 1.
The incidence of spinal epidural abscess (SEA) is rising, yet there are few reports discussing readmission rates or predisposing factors for readmission after treatment. The aims of the present study were to determine the rate of 90-day readmission following medical or surgical treatment of SEA in an urban population, identify patients at increased risk for readmission, and delineate the principal causes of readmission.
Neurosurgery records from two large urban institutions were reviewed to identify patients who were treated for SEA. Patients who died during admission or were discharged to hospice were excluded. Univariate analysis was performed using chi-square and Student t-tests to identify potential predictors of readmission. A multivariate logistic regression model, controlled for age, body mass index, sex, and institution, was used to determine significant predictors of readmission.
Of 103 patients with identified SEA, 97 met the inclusion criteria. Their mean age was 57.1 years, and 56 patients (57.7%) were male. The all-cause 90-day readmission rate was 37.1%. Infection (sepsis, osteomyelitis, persistent abscess, bacteremia) was the most common cause of readmission, accounting for 36.1% of all readmissions. Neither pretreatment neurological deficit (p = 0.16) nor use of surgical versus medical management (p = 0.33) was significantly associated with readmission. Multivariate analysis identified immunocompromised status (p = 0.036; OR 3.5, 95% CI 1.1-11.5) and hepatic disease (chronic hepatitis or alcohol abuse) (p = 0.033; OR 2.9, 95% CI 1.1-7.7) as positive predictors of 90-day readmission.
The most common indication for readmission was persistent infection. Readmission was unrelated to baseline neurological status or management strategy. However, both hepatic disease and baseline immunosuppression significantly increased the odds of 90-day readmission after SEA treatment. Patients with these conditions may require closer follow-up upon discharge to reduce overall morbidity and hospital costs associated with SEA.
脊柱硬膜外脓肿（SEA）的发病率正在上升，但很少有报告讨论再入院率或治疗后再入院的易感因素。本研究的目的是确定城市人群中SEA接受内科或外科治疗后90天再入院率，识别再入院风险增加的患者，并描述再入院的主要原因。
回顾了两家大型城市机构的神经外科记录，以确定接受SEA治疗的患者。排除住院期间死亡或出院至临终关怀机构的患者。采用卡方检验和学生t检验进行单因素分析，以确定再入院的潜在预测因素。使用多因素逻辑回归模型，控制年龄、体重指数、性别和机构，以确定再入院的显著预测因素。
在103例确诊SEA的患者中，97例符合纳入标准。他们的平均年龄为57.1岁，56例（57.7%）为男性。全因90天再入院率为37.1%。感染（脓毒症、骨髓炎、持续性脓肿、菌血症）是再入院最常见的原因，占所有再入院的36.1%。治疗前神经功能缺损（p = 0.16）以及采用手术治疗还是内科治疗（p = 0.33）均与再入院无显著相关性。多因素分析确定免疫功能低下状态（p = 0.036；OR 3.5，95%CI 1.1 - 11.5）和肝脏疾病（慢性肝炎或酒精滥用）（p = 0.033；OR 2.9，95%CI 1.1 - 7.7）是90天再入院的阳性预测因素。
再入院最常见的原因是持续性感染。再入院与基线神经功能状态或治疗策略无关。然而，肝脏疾病和基线免疫抑制均显著增加了SEA治疗后90天再入院的几率。患有这些疾病的患者出院后可能需要更密切的随访，以降低与SEA相关的总体发病率和住院费用。
