Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis
Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to tho...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-11-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/22/5451 |
| _version_ | 1797509877738766336 |
|---|---|
| author | Jeong Hwan Lee Jihye Kim Tae-Hwan Kim |
| author_facet | Jeong Hwan Lee Jihye Kim Tae-Hwan Kim |
| author_sort | Jeong Hwan Lee |
| collection | DOAJ |
| description | Older patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk. |
| first_indexed | 2024-03-10T05:23:57Z |
| format | Article |
| id | doaj.art-afb5b1b08fa24a1182e8778fd3625067 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T05:23:57Z |
| publishDate | 2021-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-afb5b1b08fa24a1182e8778fd36250672023-11-22T23:51:38ZengMDPI AGJournal of Clinical Medicine2077-03832021-11-011022545110.3390/jcm10225451Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral OsteomyelitisJeong Hwan Lee0Jihye Kim1Tae-Hwan Kim2Spine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Anyang 14068, KoreaDepartment of Pediatrics, Division of Infection, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 05355, KoreaSpine Center, Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Gyeonggi-do, Anyang 14068, KoreaOlder patients with pyogenic vertebral osteomyelitis (PVO) usually have more medical comorbidities compared with younger patients, and present with advanced infections from different causative organisms. To aid surgical decision-making, we compared surgical outcomes of older patients with PVO to those who underwent nonoperative treatment. We identified the risk factors for adverse post-operative outcomes, and analyzed the clinical risks from further spinal instrumentation. This retrospective comparative study included 439 patients aged ≥75 years with PVO. Multivariable analysis was performed to compare treatment outcomes among three groups: 194, 130, and 115 patients in the non-operative, non-instrumented, and instrumented groups, respectively. The risk factors for adverse outcomes after surgical treatment were evaluated using a logistic regression model, and the estimates of the multivariable models were internally validated using bootstrap samples. Recurrence and mortality of these patients were closely associated with neurologic deficits, and increased surgical invasiveness, resulting from additional spinal instrumentation, did not increase the risk of recurrence or mortality. We propose that surgical treatment for these patients should focus on improving neurologic deficits through immediate and sufficient removal of abscesses. Spinal instrumentation can be performed if indicated, within reasonable clinical risk.https://www.mdpi.com/2077-0383/10/22/5451pyogenic vertebral osteomyelitisspondylodiscitisneurologic deficitspinal surgerydecompressioninstrumentation |
| spellingShingle | Jeong Hwan Lee Jihye Kim Tae-Hwan Kim Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis Journal of Clinical Medicine pyogenic vertebral osteomyelitis spondylodiscitis neurologic deficit spinal surgery decompression instrumentation |
| title | Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis |
| title_full | Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis |
| title_fullStr | Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis |
| title_full_unstemmed | Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis |
| title_short | Clinical Outcomes in Older Patients Aged over 75 Years Who Underwent Early Surgical Treatment for Pyogenic Vertebral Osteomyelitis |
| title_sort | clinical outcomes in older patients aged over 75 years who underwent early surgical treatment for pyogenic vertebral osteomyelitis |
| topic | pyogenic vertebral osteomyelitis spondylodiscitis neurologic deficit spinal surgery decompression instrumentation |
| url | https://www.mdpi.com/2077-0383/10/22/5451 |
| work_keys_str_mv | AT jeonghwanlee clinicaloutcomesinolderpatientsagedover75yearswhounderwentearlysurgicaltreatmentforpyogenicvertebralosteomyelitis AT jihyekim clinicaloutcomesinolderpatientsagedover75yearswhounderwentearlysurgicaltreatmentforpyogenicvertebralosteomyelitis AT taehwankim clinicaloutcomesinolderpatientsagedover75yearswhounderwentearlysurgicaltreatmentforpyogenicvertebralosteomyelitis |