Vertebral Osteomyelitis: A Mortality Analysis Comparing Surgical and Conservative Management

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Epidemiology

Background:

• Vertebral osteomyelitis (VO) is a serious spinal infection.
• Treatment decisions for VO involve surgical versus conservative management.
• Understanding mortality predictors is crucial for patient outcomes.

Purpose of the Study:

• To compare mortality rates between surgical and conservative treatment for VO.
• To develop a predictive model for mortality risk in VO patients.

Main Methods:

• Retrospective cohort study of 125 VO patients (2004-2014).
• Standardized treatment guidelines were followed.
• LASSO penalized Cox regression analysis was used to build a predictive model for 2-year survival.

Main Results:

• No significant difference in 1- or 2-year mortality between surgical and conservative groups.
• 2-year survival was estimated at 0.82.
• Predictive model identified Charlson Comorbidity Index (CCI), cardiovascular disease, C-reactive protein (CRP) normalization, thoracic infection, and Karnofsky score as significant mortality predictors (AUC 0.74-0.77).

Conclusions:

• Surgical VO management, under standardized guidelines, does not increase mortality risk compared to conservative care.
• A validated predictive model can identify patients at higher risk of mortality.
• Key mortality predictors include CCI, CRP normalization, cardiovascular disease, thoracic infection, and Karnofsky score.