Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Apr 15;44(8):E500-E509.
doi: 10.1097/BRS.0000000000002875.

30-day Mortality Following Surgery for Spinal Epidural Abscess: Incidence, Risk Factors, Predictive Algorithm, and Associated Complications

Jerry Y Du  1   2 , Adam J Schell  1 , Chang-Yeon Kim  1 , Nikunj N Trivedi  1 , Uri M Ahn  3 , Nicholas U Ahn  1
Affiliations

30-day Mortality Following Surgery for Spinal Epidural Abscess: Incidence, Risk Factors, Predictive Algorithm, and Associated Complications

Jerry Y Du et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective case-control study.

Objective: To determine incidence and timing of mortality following surgery for spinal epidural abscess (SEA), identify risk factors for mortality, and identify complications associated with mortality.

Summary of background data: SEA is a serious condition with potentially devastating sequelae. There is a paucity of literature characterizing mortality following surgery for SEA.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was used. Patients with a diagnosis of SEA were included. A Cox proportional hazards model identified independent risk factors for 30-day mortality. A predictive model for mortality was created. Multivariate models identified postoperative complications associated with mortality.

Results: There were 1094 patients included, with 40 cases of mortality (3.7%), the majority of which occurred within 2 weeks postoperatively (70%). Independent risk factors for 30-day mortality were age>60 years (hazard ratio [HR]: 2.147, P = 0.027), diabetes (HR: 2.242, P = 0.015), respiratory comorbidities (HR: 2.416, P = 0.037), renal comorbidities (HR: 2.556, P = 0.022), disseminated cancer (HR: 5.219, P = 0.001), and preoperative thrombocytopenia (HR: 3.276, P = 0.001). A predictive algorithm predicts a 0.3% mortality for zero risk factors up to 37.5% for 4 or more risk factors. A ROC area under curve (AUC) was 0.761, signifying a fair predictor (95% CI: 0.683-0.839, P < 0.001). Cardiac arrest (adjusted odds ratio [aOR]: 72.240, 95% confidence interval [CI]: 27.8-187.721, P < 0.001), septic shock (aOR: 15.382, 95% CI: 7.604-31.115, P < 0.001), and pneumonia (aOR: 2.84, 95% CI: 1.109-7.275, P = 0.03) were independently associated with mortality.

Conclusion: The 30-day mortality rate following surgery for SEA was 3.7%. Of the mortalities that occurred within 30 days of surgery, the majority occurred within 2 weeks. Independent risk factors for mortality included older age, diabetes, hypertension, respiratory comorbidities, renal comorbidities, metastatic cancer, and thrombocytopenia. Risk for mortality ranged from 0.3% to 37.5% based on number of risk factors. Septic shock, cardiac arrest, and pneumonia were associated with mortality.

Level of evidence: 3.

PubMed Disclaimer

References

    1. Vakili M, Crum-Cianflone NF. Spinal epidural abscess: a series of 101 cases. Am J Med 2017; 130:1458–1463.
    1. Darouiche RO. Spinal epidural abscess. N Engl J Med 2006; 355:2012–2020.
    1. Akalan N, Ozgen T. Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases. Acta Neurochir 2000; 142:17–23.
    1. Dandy WE. Abscesses and inflammatory tumors in the spinal epidural space (so-called pachymeningitis externa). Arch Surg 1926; 13:477–494.
    1. Davis DP, Wold RM, Patel RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med 2004; 26:285–291.

MeSH terms