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Early surgery may lower mortality in patients suffering from severe spinal infection

PURPOSE: Spinal infection (SI) is a life-threatening condition and treatment remains challenging. Numerous factors influence the outcome of SI and both conservative and operative care can be applied. As SI is associated with mortality rates between 2 and 20% even in developed countries, the purpose...

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Autores principales: Lener, Sara, Wipplinger, Christoph, Stocsits, Anna, Hartmann, Sebastian, Hofer, Anja, Thomé, Claudius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Vienna 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550317/
https://www.ncbi.nlm.nih.gov/pubmed/32728904
http://dx.doi.org/10.1007/s00701-020-04507-2
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author Lener, Sara
Wipplinger, Christoph
Stocsits, Anna
Hartmann, Sebastian
Hofer, Anja
Thomé, Claudius
author_facet Lener, Sara
Wipplinger, Christoph
Stocsits, Anna
Hartmann, Sebastian
Hofer, Anja
Thomé, Claudius
author_sort Lener, Sara
collection PubMed
description PURPOSE: Spinal infection (SI) is a life-threatening condition and treatment remains challenging. Numerous factors influence the outcome of SI and both conservative and operative care can be applied. As SI is associated with mortality rates between 2 and 20% even in developed countries, the purpose of the present study was to investigate the occurrence and causes of death in patients suffering from SI. METHODS: A retrospective analysis was performed on 197 patients, categorized into two groups according to their outcome: D (death) and S (survival). The diagnosis was based on clinical and imaging (MRI) findings. Data collected included demographics, clinical characteristics, comorbidities, infection parameters, treatment details, outcomes, and causes of death. RESULTS: The number of deaths was significantly higher in the conservative group (n = 9/51, 18%) compared with the operative counterpart (n = 8/146, 6%; p = 0.017). Death caused by septic multiorgan failure was the major cause of fatalities (n = 10/17, 59%) followed by death due to cardiopulmonary reasons (n = 4/17, 24%). The most frequent indication for conservative treatment in patients of group D included “highest perioperative risk” (n = 5/17, 29%). CONCLUSION: We could demonstrate a significantly higher mortality rate in patients solely receiving conservative treatment. Mortality is associated with number and type of comorbidities, but also tends to be correlated with primarily acquired infection. As causes of death are predominantly associated with a septic patient state or progression of disease, our data may call for an earlier and more aggressive treatment. Nevertheless, prospective clinical trials will be mandatory to better understand the pathogenesis and course of spinal infection, and to develop high quality, evidence-based treatment recommendations.
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spelling pubmed-75503172020-10-19 Early surgery may lower mortality in patients suffering from severe spinal infection Lener, Sara Wipplinger, Christoph Stocsits, Anna Hartmann, Sebastian Hofer, Anja Thomé, Claudius Acta Neurochir (Wien) Original Article - Infection PURPOSE: Spinal infection (SI) is a life-threatening condition and treatment remains challenging. Numerous factors influence the outcome of SI and both conservative and operative care can be applied. As SI is associated with mortality rates between 2 and 20% even in developed countries, the purpose of the present study was to investigate the occurrence and causes of death in patients suffering from SI. METHODS: A retrospective analysis was performed on 197 patients, categorized into two groups according to their outcome: D (death) and S (survival). The diagnosis was based on clinical and imaging (MRI) findings. Data collected included demographics, clinical characteristics, comorbidities, infection parameters, treatment details, outcomes, and causes of death. RESULTS: The number of deaths was significantly higher in the conservative group (n = 9/51, 18%) compared with the operative counterpart (n = 8/146, 6%; p = 0.017). Death caused by septic multiorgan failure was the major cause of fatalities (n = 10/17, 59%) followed by death due to cardiopulmonary reasons (n = 4/17, 24%). The most frequent indication for conservative treatment in patients of group D included “highest perioperative risk” (n = 5/17, 29%). CONCLUSION: We could demonstrate a significantly higher mortality rate in patients solely receiving conservative treatment. Mortality is associated with number and type of comorbidities, but also tends to be correlated with primarily acquired infection. As causes of death are predominantly associated with a septic patient state or progression of disease, our data may call for an earlier and more aggressive treatment. Nevertheless, prospective clinical trials will be mandatory to better understand the pathogenesis and course of spinal infection, and to develop high quality, evidence-based treatment recommendations. Springer Vienna 2020-07-29 2020 /pmc/articles/PMC7550317/ /pubmed/32728904 http://dx.doi.org/10.1007/s00701-020-04507-2 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Article - Infection
Lener, Sara
Wipplinger, Christoph
Stocsits, Anna
Hartmann, Sebastian
Hofer, Anja
Thomé, Claudius
Early surgery may lower mortality in patients suffering from severe spinal infection
title Early surgery may lower mortality in patients suffering from severe spinal infection
title_full Early surgery may lower mortality in patients suffering from severe spinal infection
title_fullStr Early surgery may lower mortality in patients suffering from severe spinal infection
title_full_unstemmed Early surgery may lower mortality in patients suffering from severe spinal infection
title_short Early surgery may lower mortality in patients suffering from severe spinal infection
title_sort early surgery may lower mortality in patients suffering from severe spinal infection
topic Original Article - Infection
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550317/
https://www.ncbi.nlm.nih.gov/pubmed/32728904
http://dx.doi.org/10.1007/s00701-020-04507-2
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