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  • Incidence and Risk Factors for 90-day Readmission Following Medical and Surgical Management of Spinal Epidural Abscess: A Multi-institutional Study

    Final Number:

    Michael Longo BA; Yaroslav Jacob Gelfand MD; Zach Pennington BS; Rafael De la Garza Ramos MD; Murray Echt MD; Ali Karim Ahmed BS MD candidate; Daniel M. Sciubba MD; Merritt Drew Kinon MD; Reza Yassari MD

    Study Design:

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    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2019

    Introduction: 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 aim of the present study is to determine the rate of 90-day readmission following medical and surgical treatment of SEA in an urban population and to identify patients at greater risk for readmission.

    Methods: Neurosurgery records from two large urban institutions were reviewed to identify patients that were diagnosed with and treated for SEA. Patients that died during admission or were discharged to hospice were excluded from the study. Univariate analysis was performed using chi-square and Student’s t-tests to identify independent variables predicting readmission with a p-value <0.10. A multivariate logistic regression model controlled for age, body mass index (BMI), gender, and institution was used to determine significant predictors of readmission.

    Results: Of 103 patients in our database with SEA, 97 patients met the inclusion criteria. Mean age was 57.1 (±13.5) 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 and accounted for 13 readmissions (36.1%). Neither pre-treatment Frankel grade (p=0.12) nor surgical versus medical management (p=0.33) were significantly associated with readmission. Multivariate analysis showed that immunocompromised status (p=0.016; OR 4.6 [95% CI 1.3-15.7]) and hepatic disease (chronic hepatitis or alcohol abuse) (p=0.015; OR 3.7 [95% CI 1.3-10.6]) were significantly associated with 90-day readmission.

    Conclusions: Patients with hepatic disease and patients who were immunosuppressed demonstrated significantly increased odds of 90-day readmission after SEA treatment. These patients may require closer follow-up upon discharge to reduce overall morbidity and hospital costs associated with SEA. There was no significant difference in readmission rate between surgical and non-surgical patients.

    Patient Care: With this information, surgeons may be able to better identify patients at high risk for readmission and anticipate causes of readmission after SEA treatment

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe characteristics of SEA patients which predispose them to readmission; 2) Identify the most common cause of readmission in SEA patients; and 3) Discuss whether there is a difference between surgical and medical management of SEA with respect to readmission


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