背景:脊髓硬膜外脓肿(SEA)是硬膜外腔内一种罕见且危及生命的感染,具有明显的功能损害和发病率。关于是否为SEAs运作仍有积极的辩论,有限的现有数据比较手术和非手术治疗后的长期生存能力。
目的:本研究旨在确定接受SEA手术和非手术治疗的患者的长期生存率。
方法:回顾性队列研究患者样本:250例连续SEA患者预后指标:生存率/死亡率,并发症方法:对2000年1月至2020年6月在三级医疗中心接受初级SEA治疗的所有患者进行鉴定.数据收集是通过回顾性图表审查。Cox比例风险回归模型用于所有生存分析,同时控制潜在的混杂变量并进行多次测试校正。
结果:250例患者中有35例死亡,全因死亡率为14%。超过一半的死亡发生在治疗后90天内。90天,3年,5年生存率为92.8%,89.2%,和86.4%,分别。在手术患者中,全因死亡率为13.07%,相比之下,医学管理的患者为16.22%。与药物治疗相比,手术治疗(减压/融合/清创)可显著降低死亡风险62.4%(p=0.03),但手术患者的平均住院时间明显延长(p=.01).短期死亡的危险因素包括低蛋白血症(<3.5g/dL),ASA4+,还有心脏骤停.长期死亡的危险因素是免疫功能低下状态,白细胞计数升高>12,000,败血症,感染性休克,ASA4+,和心脏骤停(p<0.05)。在并发症方面,手术治疗的患者深静脉血栓形成比例较高(p<.05).
结论:在这项研究中,SEA治疗的总体长期生存能力相对较高(5年为86%)。确定了以下SEA死亡风险因素:低白蛋白血症(短期),免疫受损状态(长期),白细胞增多(长期),脓毒症/脓毒性休克(长期),ASA4+和心脏骤停(总体)。对于主要的SEA患者,与非手术治疗相比,手术治疗可降低死亡风险.
BACKGROUND: Spinal epidural abscess (SEA) is a rare and life-threatening infection within the epidural space with significant functional impairment and morbidity. Active debate remains over whether to operate for SEAs, with limited existing data comparing the long-term survivability after surgical versus nonsurgical management.
OBJECTIVE: This study aims to determine the long-term survival of patients who underwent surgical and nonsurgical management for SEA.
METHODS: Retrospective cohort study.
METHODS: A total of 250 consecutive SEA patients.
METHODS: Survival and mortality rates, complications.
METHODS: All patients treated at a tertiary medical center for a primary SEA from January 2000 to June 2020 are identified. Data collection is by retrospective chart review. Cox proportional hazards regression models are used for all survival analyses while controlling for potential confounding variables and with multiple testing corrections.
RESULTS: A total of 35 out of 250 patients died with an overall all-cause mortality of 14%. More than half of all deaths occurred within 90 days after treatment. The 90-day, 3-year, and 5-year survival rates are 92.8%, 89.2%, and 86.4%, respectively. Among surgery patients, the all-cause mortality was 13.07%, compared to 16.22% for medically-managed patients. Surgical treatment (decompression, fusion, debridement) significantly reduced the risk of death by 62.4% compared to medical therapy (p=.03), but surgery patients experienced a significantly longer mean length of stay (p=.01). Risk factors of short-term mortality included hypoalbuminemia (<3.5 g/dL), American Society of Anesthesiologists (ASA) 4+, and cardiac arrest. Risk factors of long-term mortality were immunocompromised state, elevated WBC count >12,000, sepsis, septic shock, ASA 4+, and cardiac arrest (p<.05). In terms of complications, surgically-managed patients experienced a higher proportion of deep vein thrombosis (p<.05).
CONCLUSIONS: The overall long-term survivability of SEA treatment is relatively high at (86% at 5-year) in this study. The following SEA mortality risk factors were identified: hypoalbuminemia (short-term), immunocompromised state (long-term), leukocytosis (long-term), sepsis and septic shock (long-term), ASA 4+ and cardiac arrest (overall). For primary SEA patients, surgical management may reduce mortality risk compared to nonsurgical management.