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Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO. METHODS: All patients with a diagnosis of VO in Region...

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Autores principales: Zadran, Spogmai, Pedersen, Peter Heide, Eiskjær, Søren
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222680/
https://www.ncbi.nlm.nih.gov/pubmed/32435567
http://dx.doi.org/10.1177/2192568219862213
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author Zadran, Spogmai
Pedersen, Peter Heide
Eiskjær, Søren
author_facet Zadran, Spogmai
Pedersen, Peter Heide
Eiskjær, Søren
author_sort Zadran, Spogmai
collection PubMed
description STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO. METHODS: All patients with a diagnosis of VO in Region North Denmark from 2004 to 2014 were followed for at least 2 years or until death. They were all treated according to a standardized guideline for the choice of treatment modality. Nineteen dichotomized variables with possible influence on the mortality were registered for all patients in the study. LASSO (least absolute shrinkage and selection operator) penalized Cox regression analysis was used to build a predictive model for 2-year survival after VO. RESULTS: A total of 125 patients were eligible for inclusion, mean age 67 years, 36 women. 75 were treated surgically. Twenty-one patients were dead 2 years after the diagnosis. Kaplan-Meier estimate of 2-year survival was 0.82 [0.75, 0.88]. Any difference in mortality between surgically and conservatively treated patients was nonsignificant at 1 and 2 years (univariate Cox regression analysis). Significant factors included in the predictive model after LASSO penalized Cox regression analysis was Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score. The area under the curve (AUC) for the predictive model ranged from 0.74 to 0.77. CONCLUSION: Patients undergoing surgical management for vertebral osteomyelitis according to standardized and agreed-upon guidelines had no higher mortality than those allocated to conservative treatment. The predictive model included 5 variables associated with an increased mortality: CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score.
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spelling pubmed-72226802020-05-20 Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management Zadran, Spogmai Pedersen, Peter Heide Eiskjær, Søren Global Spine J Original Articles STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To compare the mortality between patients treated for vertebral osteomyelitis (VO) with either surgical or conservative management and to construct a predictive model for mortality after VO. METHODS: All patients with a diagnosis of VO in Region North Denmark from 2004 to 2014 were followed for at least 2 years or until death. They were all treated according to a standardized guideline for the choice of treatment modality. Nineteen dichotomized variables with possible influence on the mortality were registered for all patients in the study. LASSO (least absolute shrinkage and selection operator) penalized Cox regression analysis was used to build a predictive model for 2-year survival after VO. RESULTS: A total of 125 patients were eligible for inclusion, mean age 67 years, 36 women. 75 were treated surgically. Twenty-one patients were dead 2 years after the diagnosis. Kaplan-Meier estimate of 2-year survival was 0.82 [0.75, 0.88]. Any difference in mortality between surgically and conservatively treated patients was nonsignificant at 1 and 2 years (univariate Cox regression analysis). Significant factors included in the predictive model after LASSO penalized Cox regression analysis was Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score. The area under the curve (AUC) for the predictive model ranged from 0.74 to 0.77. CONCLUSION: Patients undergoing surgical management for vertebral osteomyelitis according to standardized and agreed-upon guidelines had no higher mortality than those allocated to conservative treatment. The predictive model included 5 variables associated with an increased mortality: CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score. SAGE Publications 2019-07-10 2020-06 /pmc/articles/PMC7222680/ /pubmed/32435567 http://dx.doi.org/10.1177/2192568219862213 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Zadran, Spogmai
Pedersen, Peter Heide
Eiskjær, Søren
Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
title Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
title_full Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
title_fullStr Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
title_full_unstemmed Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
title_short Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management
title_sort vertebral osteomyelitis: a mortality analysis comparing surgical and conservative management
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7222680/
https://www.ncbi.nlm.nih.gov/pubmed/32435567
http://dx.doi.org/10.1177/2192568219862213
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