- OBJECTIVE: Spondylodiscitis management poses significant clinical challenges, particularly regarding the indication and timing of surgical intervention, especially in critically ill patients where surgical risks must be balanced against the benefits of infection control. This study aims to investigate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo spinal infections.
METHODS: This international, multicenter retrospective cohort study analyzed patients from 24 centers, predominantly in Europe, treated between 2015 and 2022. The study focused on patients severely affected by pyogenic spondylodiscitis, characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. Patients were divided into early surgery (within 3 days of admission), delayed surgery (after 3 days of admission), and conservative therapy groups. The primaryOBJECTIVE: Spondylodiscitis management poses significant clinical challenges, particularly regarding the indication and timing of surgical intervention, especially in critically ill patients where surgical risks must be balanced against the benefits of infection control. This study aims to investigate the effectiveness of early surgery versus delayed surgery or conservative management in critically ill patients with de novo spinal infections.
METHODS: This international, multicenter retrospective cohort study analyzed patients from 24 centers, predominantly in Europe, treated between 2015 and 2022. The study focused on patients severely affected by pyogenic spondylodiscitis, characterized by an initial CRP level >200 mg/l or the presence of two out of four Systemic Inflammatory Response Syndrome criteria upon admission. Patients were divided into early surgery (within 3 days of admission), delayed surgery (after 3 days of admission), and conservative therapy groups. The primary outcome was 30-day mortality. Secondary outcomes included length of ICU stay, length of hospital stay, and relapse rates.
RESULTS: The study included 192 patients (65.63% male) with a median age of 69 years. Treatments were early surgery (41.15%), delayed surgery (38.54%), and conservative therapy (18.75%). Delayed surgery was associated with significantly lower mortality (4.05%, p<0.001) compared to early surgery (27.85%, p<0.001) and conservative therapy (27.78%, p<0.001). Additionally, delayed surgery resulted in shorter hospital (p<0.001) and ICU stays (p<0.001). The optimal window for surgery, minimizing mortality, was identified as 10 to 14 days post-admission. Risk factors for increased mortality included early surgery (p<0.05), multiple organ failure (p<0.05), vertebral body destruction (p<0.05), and cervical infection localization (p<0.05).
CONCLUSION: Delayed surgical treatment was associated with significantly lower mortality and shorter hospitalization in critically ill patients with pyogenic spondylodiscitis. These findings suggest a reevaluation of current treatment protocols, emphasizing the importance of surgical timing in improving patient outcomes.…
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