Readmission after spinal epidural abscess management in urban populations: A bi-institutional study

Michael Longo, Zach Pennington, Yaroslav Gelfand, Rafael de la Garza Ramos, Murray Echt, A. Karim Ahmed, Vijay Yanamadala, Daniel M. Sciubba, Reza Yassari

Research output: Contribution to journalArticle

Abstract

OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Original languageEnglish (US)
Pages (from-to)465-472
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume32
Issue number3
DOIs
StatePublished - 2020

Keywords

  • Extradural abscess
  • Infection
  • Management
  • Readmission
  • Risk factors
  • Spinal epidural abscess

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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  • Cite this

    Longo, M., Pennington, Z., Gelfand, Y., de la Garza Ramos, R., Echt, M., Karim Ahmed, A., Yanamadala, V., Sciubba, D. M., & Yassari, R. (2020). Readmission after spinal epidural abscess management in urban populations: A bi-institutional study. Journal of Neurosurgery: Spine, 32(3), 465-472. https://doi.org/10.3171/2019.8.SPINE19790