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  • Early Intervention in Cauda Equina Syndrome for Better Outcomes: Myth or Reality? United States National Inpatient Sample (NIS) Database Analysis 2002-2011

    Final Number:

    Jai D. Thakur MD; Piyush Kalakoti MD; Christopher Storey MD PhD; Justin Haydel MD; Osama Ahmed MD; Richard P Menger MD; Anil Nanda MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Aim of the study was to determine if timing of intervention in the management of Cauda Equina syndrome (CES) had an impact on patient outcomes.

    Methods: Analysis of patients in the NIS database undergoing surgical management for CES between 2002-2011was performed. Effect of early management (Group A: <24 hours vs >24 hours; Group B: <48 hours vs >48 hours) on mortality, unfavorable discharge, prolonged length of stay(LOS), and high-end hospital charges were investigated. Group A and B were analyzed separately.

    Results: 12,374 patients underwent surgery (Group A: 11,478 patients; Group B: 12,107 patients) for CES between 2002-2011. In group A, mortality rate (0.5% vs. 1.0%), unfavorable discharge (32.4% vs. 34.6%), prolonged LOS (23.4% vs. 27.6%) and hospital charges ($76655 vs. 79603) were slightly higher in patients undergoing intervention post 24 hours. Multivariable regression model showed no difference in mortality (OR: 2.353, 95% CI: 0.524-10.565; p=0.063), unfavorable discharge (OR: 1.106, 95% CI: 0.949-1.289; p=0.199), high-end charges (OR: 1.077, 95% CI: 0.921-1.260; p=0.353) and venous thromboembolism (VTE) (OR: 1.315, 95% CI: 0.975-1.773; p=0.073) in patients undergoing surgery post 24 hours; prolonged LOS was significantly higher in the latter (OR: 1.196, 95% CI:1.018-1.406; p=0.030). In group B, mortality rate (0.5% vs. 0.7%), unfavorable discharge (32.5% vs. 34.5%), prolonged LOS (23.8% vs. 24.0%) and hospital charges ($76,793 vs. 80,284) were higher in patients undergoing intervention post 48 hours admission. Multivariable regression model showed no difference in mortality (OR: 1.424, 95% CI: 0.336-6.028; p=0.631), unfavorable discharge (OR: 1.115, 95% CI: 0.849-1.419; p=0.435), prolonged LOS (OR: 0.96, 95% CI: 0.71-1.30; p=0.795), high-end charges (OR: 1.273, 95% CI: 0.969-1.674; p=0.083), and VTE (OR: 1.451, 95% CI: 0.874-2.408; p=0.150) between the two groups in Group B.

    Conclusions: NIS-database analysis does not show any statistical evidence of better outcomes, length of stay or cost effectiveness of early intervention vs. late intervention.

    Patient Care: It may significantly change the future studies to be directed to look at the temporal patterns of interventions and outcomes in cauda equina syndromes

    Learning Objectives: 1. Effect of early intervention on outcomes in Cauda Equina syndromes


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