- Introduction: The management of septic spondylodiscitis presents a clinical challenge, with debates surrounding the timing of surgical intervention. The 2SICK study addresses the gap in knowledge concerning the efficacy of early surgery versus conservative management in these critically ill patients.
Materials and methods: A multicentric, international retrospective cohort study encompassed cases from 2015-2022. Inclusion criteria were a CRP level >200 mg/l and a septic state upon admission. Patients were stratified by treatment modality (early surgery within 3 days of admission, delayed surgery after 3 or more days of non-surgical stabilisation, and conservative therapy). Chi-square tests, univariate analyses, stepwise and regularization-tuned multivariate regression analyses were used to examine outcome differences in mortality.
Results: A total of 189 patients, with a mean age of 69 years, were evaluated. Among these, 36 underwent conservative therapy, 79 underwent early surgery,Introduction: The management of septic spondylodiscitis presents a clinical challenge, with debates surrounding the timing of surgical intervention. The 2SICK study addresses the gap in knowledge concerning the efficacy of early surgery versus conservative management in these critically ill patients.
Materials and methods: A multicentric, international retrospective cohort study encompassed cases from 2015-2022. Inclusion criteria were a CRP level >200 mg/l and a septic state upon admission. Patients were stratified by treatment modality (early surgery within 3 days of admission, delayed surgery after 3 or more days of non-surgical stabilisation, and conservative therapy). Chi-square tests, univariate analyses, stepwise and regularization-tuned multivariate regression analyses were used to examine outcome differences in mortality.
Results: A total of 189 patients, with a mean age of 69 years, were evaluated. Among these, 36 underwent conservative therapy, 79 underwent early surgery, and 74 received delayed surgery. The subgroup undergoing delayed surgery exhibited the lowest mortality rates, with 4.1%. In comparison, the mortality rates for early surgery and conservative therapy were 28.2% and 27.8%, respectively. The ideal time frame for delayed surgery, in terms of mortality, was found to be between 10 and 14 days from admission. Accounting for confounders, delayed surgery was found to be significantly associated with decreased mortality (p<0.01) compared to conservative therapy, and early surgery with increased mortality compared to conservative therapy (p<0.05). Positive predictors of mortality were found to be age, reduced GFR, raised creatinine, multiple organ failure, cervical location of the infection, erosion of endplates, presence of psoas abscess and tachycardia at admission (p<0.05). Negative predictors were days between admission and surgery and the presence of epidural abscess (p<0.05).
Conclusion: Delayed surgery was found to be associated with significantly less mortality compared to early surgery and conservative therapy in patients with septic spondylodiscitis. The likely optimal window for surgery is 10 to 14 days from admission. The strongest predictors of death were early surgery within 3 days of admission, vertebral endplate erosion, and multiple organ failure.…
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