In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

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

    Final Number:
    656

    Authors:
    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:
    Other

    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

    References:

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy