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In-Hospital mortality in Spondylodiscitis: Risk factors assessed through the National Inpatient Sample analysis.

Julius Gerstmeyer1, August Avantaggio2, Clifford Pierre3

  • 1Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA; Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA 98122, USA; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|March 22, 2025
PubMed
Summary

Spondylodiscitis (SD) in older adults has a lower in-hospital mortality rate than previously reported. Elective admission, advanced age, paralysis, and pneumonia are key risk factors for mortality in SD patients.

Keywords:
DiscitisMortalityRisk factorsSpine infectionSpondylodiscitis

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Area of Science:

  • Infectious Diseases
  • Orthopedics
  • Public Health

Background:

  • Spondylodiscitis (SD) presents diagnostic and treatment challenges, particularly in an aging population with comorbidities.
  • Despite advancements, in-hospital mortality for SD remains significant, with prior studies lacking clarity on mortality causes.
  • This study aims to analyze in-hospital mortality and identify risk factors in SD patients using the National Inpatient Sample (NIS).

Purpose of the Study:

  • To assess in-hospital mortality rates for spondylodiscitis across different age groups.
  • To identify independent risk factors associated with mortality in patients diagnosed with spondylodiscitis.
  • To compare mortality rates and risk factors with previous findings in the literature.

Main Methods:

  • The 2020 National Inpatient Sample (NIS) database was utilized, including adult patients with a primary diagnosis of spondylodiscitis (ICD-10 Codes M46.2x, M46.3x, M46.4x).
  • Data on demographics, admission details, clinical information, comorbidities, and surgical treatments were extracted.
  • Multivariable logistic regression analysis was performed to determine independent risk factors for in-hospital mortality, with age categorized into <65, 65-79, and ≥80 years.

Main Results:

  • A total of 3,975 patients were analyzed, with an overall in-hospital mortality rate of 0.9%.
  • The mortality group was significantly older (mean age 70.86 years vs. 58.74 years) and more likely to have elective admissions.
  • Independent risk factors for mortality included advanced age (especially <65 years), elective admission status, paralysis, and pneumonia. Chronic diseases were more prevalent in the mortality group.

Conclusions:

  • Spondylodiscitis management remains complex, but this study observed lower in-hospital mortality and length of stay compared to prior research.
  • Elective admission status emerged as the strongest predictor of mortality, underscoring the importance of early diagnosis and intervention.
  • Patients over 65, particularly octogenarians, are at higher risk, and identified mortality risk factors may differ from etiological factors, warranting further investigation.