A propensity-score-matched multicenter cohort study comparing mortality in conservative vs. surgical treatment of pyogenic spondylodiscitis
Andreas Kramer (Mainz), Jonathan Neuhoff (Frankfurt a. M.), Santhosh G. Thavarajasingam (Mainz), Ann-Kathrin Jörger (München), Hariharan Subbiah Ponniah (London / GB), Daniele S. C. Ramsay (London / GB), Benjamin Davies (Cambridge / GB), Bernhard Meyer (München), Frank Kandziora (Frankfurt a. M.), Ehab Shiban (Augsburg), Andreas Demetriades (Edinburgh / GB), Florian Ringel (Mainz)
The optimal treatment approach for patients with spinal infections remains a topic of debate and fundamentally different therapeutic concepts are observed within Europe. This study aimed to compare outcomes between conservative and surgical treatment in primary pyogenic spondylodiscitis using an international cohort analysis.
The study utilized retrospective data from spine centers (2017-2022) on primary spondylodiscitis, comparing treatments through propensity score matching of the conservative and surgical patient cohorts. Primary outcome was mortality, secondary outcomes included neurological impairment and infection relapse.
A total of 392 patients were analyzed, with a mean age of 68 years (155 females, 237 males). Among them, 95 cases received conservative treatment (CoT) and 297 cases underwent surgery (SuT). The majority of conservatively treated patients were in the United Kingdom (CoT 81, SuT 7), while the majority of surgically treated cases were in Germany (CoT 14, SuT 290). In the pre-matched analysis, there were no significant differences in disease characteristics between the two groups. However, the overall mortality rate was significantly higher in the conservative treatment group (p<0.001). The propensity-matched analysis resulted in two equal cohorts of 95 patients each. The matched analysis revealed a significantly higher mortality rate in the conservative treatment group (24.2% for CoT vs. 6.3% for SuT, p<0.01). There were no significant differences in relapse (CoT 6.3%, SuT 7.3%, p=0.64) or neurological status at discharge (CoT 22.1%, SuT 14.7%, p=0.27).Multivariate regression analysis revealed that age, white cell count, conservative treatment, diabetes, and malignancy were identified as significant predictive factors for mortality. Regarding relapse, both white cell count and age were found to be significant predictive factors. In terms of neurological status, age emerged as the sole significant predictive factor.
This international data analysis, with its inherent limitations, supports the growing evidence of significantly reduced mortality rates associated with surgical therapy compared to conservative treatment for primary pyogenic spondylodiscitis. Although relapse rates and neurological deficits did not differ significantly between the two approaches, the findings highlight the importance of considering surgical intervention to improve patient outcomes in these cases.
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