Outcomes of decompression and fusion for treatment of spinal infection

Nicholas Dietz, Mayur Sharma, Ahmad Alhourani, Beatrice Ugiliweneza, Dengzhi Wang, Miriam A Nuno, Doniel Drazin, Maxwell Boakye

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE Spine infection including vertebral osteomyelitis, discitis, paraspinal musculoskeletal infection, and spinal abscess refractory to medical management poses significant challenges to the treating physician. Surgical management is often required in patients suffering neurological deficits or spinal deformity with significant pain. To date, best practices have not been elucidated for the optimization of health outcomes and resource utilization in the setting of surgical intervention for spinal infection. The authors conducted the present study to assess the magnitude of reoperation rates in both fusion and nonfusion groups as well as overall health resource utilization following surgical decompression for spine infection. METHODS The authors performed an analysis using MarketScan (2001-2015) to identify health outcomes and healthcare utilization metrics of spine infection following surgical intervention with decompression alone or combined with fusion. Adult patients underwent surgical management for primary or secondary spinal infection and were followed up for at least 12 months postoperatively. Assessed outcomes included reoperation, healthcare utilization and payment at the index hospitalization and within 12 months after discharge, postoperative complications, and infection recurrence. RESULTS A total of 2662 patients in the database were eligible for inclusion in this study. Rehospitalization for infection was observed in 3.99% of patients who had undergone fusion and in 11.25% of those treated with decompression alone. Reoperation was needed in 12.7% of the patients without fusion and 8.16% of those with fusion. Complications within 30 days were more common in the nonfusion group (24.64%) than in the fusion group (16.49%). Overall postoperative payments after 12 months totaled $33,137 for the nonfusion group and $23,426 for the fusion group. CONCLUSIONS In this large cohort study with a 12-month follow-up, the recurrence of infection, reoperation rates, and complications were higher in patients treated with decompression alone than in those treated with decompression plus fusion. These findings along with imaging characteristics, disease severity, extent of bony resection, and the presence of instability may help surgeons decide whether to include fusion at the time of initial surgery. Further studies that control for selection bias in appropriately matched cohorts are necessary to determine the additive benefits of fusion in spinal infection management.

Original languageEnglish (US)
JournalNeurosurgical Focus
Volume46
Issue number1
DOIs
StatePublished - Jan 1 2019

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Spinal Fusion
Decompression
Infection
Reoperation
Spine
Therapeutics
Health Resources
Discitis
Delivery of Health Care
Surgical Decompression
Recurrence
Selection Bias
Osteomyelitis
Coinfection
Practice Guidelines
Abscess
Hospitalization
Cohort Studies
Databases
Physicians

Keywords

  • Complications
  • Decompression
  • Fusion
  • Spinal infection
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Dietz, N., Sharma, M., Alhourani, A., Ugiliweneza, B., Wang, D., Nuno, M. A., ... Boakye, M. (2019). Outcomes of decompression and fusion for treatment of spinal infection. Neurosurgical Focus, 46(1). https://doi.org/10.3171/2018.10.FOCUS18460

Outcomes of decompression and fusion for treatment of spinal infection. / Dietz, Nicholas; Sharma, Mayur; Alhourani, Ahmad; Ugiliweneza, Beatrice; Wang, Dengzhi; Nuno, Miriam A; Drazin, Doniel; Boakye, Maxwell.

In: Neurosurgical Focus, Vol. 46, No. 1, 01.01.2019.

Research output: Contribution to journalArticle

Dietz, N, Sharma, M, Alhourani, A, Ugiliweneza, B, Wang, D, Nuno, MA, Drazin, D & Boakye, M 2019, 'Outcomes of decompression and fusion for treatment of spinal infection', Neurosurgical Focus, vol. 46, no. 1. https://doi.org/10.3171/2018.10.FOCUS18460
Dietz, Nicholas ; Sharma, Mayur ; Alhourani, Ahmad ; Ugiliweneza, Beatrice ; Wang, Dengzhi ; Nuno, Miriam A ; Drazin, Doniel ; Boakye, Maxwell. / Outcomes of decompression and fusion for treatment of spinal infection. In: Neurosurgical Focus. 2019 ; Vol. 46, No. 1.
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abstract = "OBJECTIVE Spine infection including vertebral osteomyelitis, discitis, paraspinal musculoskeletal infection, and spinal abscess refractory to medical management poses significant challenges to the treating physician. Surgical management is often required in patients suffering neurological deficits or spinal deformity with significant pain. To date, best practices have not been elucidated for the optimization of health outcomes and resource utilization in the setting of surgical intervention for spinal infection. The authors conducted the present study to assess the magnitude of reoperation rates in both fusion and nonfusion groups as well as overall health resource utilization following surgical decompression for spine infection. METHODS The authors performed an analysis using MarketScan (2001-2015) to identify health outcomes and healthcare utilization metrics of spine infection following surgical intervention with decompression alone or combined with fusion. Adult patients underwent surgical management for primary or secondary spinal infection and were followed up for at least 12 months postoperatively. Assessed outcomes included reoperation, healthcare utilization and payment at the index hospitalization and within 12 months after discharge, postoperative complications, and infection recurrence. RESULTS A total of 2662 patients in the database were eligible for inclusion in this study. Rehospitalization for infection was observed in 3.99{\%} of patients who had undergone fusion and in 11.25{\%} of those treated with decompression alone. Reoperation was needed in 12.7{\%} of the patients without fusion and 8.16{\%} of those with fusion. Complications within 30 days were more common in the nonfusion group (24.64{\%}) than in the fusion group (16.49{\%}). Overall postoperative payments after 12 months totaled $33,137 for the nonfusion group and $23,426 for the fusion group. CONCLUSIONS In this large cohort study with a 12-month follow-up, the recurrence of infection, reoperation rates, and complications were higher in patients treated with decompression alone than in those treated with decompression plus fusion. These findings along with imaging characteristics, disease severity, extent of bony resection, and the presence of instability may help surgeons decide whether to include fusion at the time of initial surgery. Further studies that control for selection bias in appropriately matched cohorts are necessary to determine the additive benefits of fusion in spinal infection management.",
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N2 - OBJECTIVE Spine infection including vertebral osteomyelitis, discitis, paraspinal musculoskeletal infection, and spinal abscess refractory to medical management poses significant challenges to the treating physician. Surgical management is often required in patients suffering neurological deficits or spinal deformity with significant pain. To date, best practices have not been elucidated for the optimization of health outcomes and resource utilization in the setting of surgical intervention for spinal infection. The authors conducted the present study to assess the magnitude of reoperation rates in both fusion and nonfusion groups as well as overall health resource utilization following surgical decompression for spine infection. METHODS The authors performed an analysis using MarketScan (2001-2015) to identify health outcomes and healthcare utilization metrics of spine infection following surgical intervention with decompression alone or combined with fusion. Adult patients underwent surgical management for primary or secondary spinal infection and were followed up for at least 12 months postoperatively. Assessed outcomes included reoperation, healthcare utilization and payment at the index hospitalization and within 12 months after discharge, postoperative complications, and infection recurrence. RESULTS A total of 2662 patients in the database were eligible for inclusion in this study. Rehospitalization for infection was observed in 3.99% of patients who had undergone fusion and in 11.25% of those treated with decompression alone. Reoperation was needed in 12.7% of the patients without fusion and 8.16% of those with fusion. Complications within 30 days were more common in the nonfusion group (24.64%) than in the fusion group (16.49%). Overall postoperative payments after 12 months totaled $33,137 for the nonfusion group and $23,426 for the fusion group. CONCLUSIONS In this large cohort study with a 12-month follow-up, the recurrence of infection, reoperation rates, and complications were higher in patients treated with decompression alone than in those treated with decompression plus fusion. These findings along with imaging characteristics, disease severity, extent of bony resection, and the presence of instability may help surgeons decide whether to include fusion at the time of initial surgery. Further studies that control for selection bias in appropriately matched cohorts are necessary to determine the additive benefits of fusion in spinal infection management.

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