Operative Management of Spinal Infection among Intravenous Drug Users.
World Neurosurg. 2019 Jan 10;:
Authors: Reid DBC, Haglin JM, Durand WM, Daniels AH
Abstract
PURPOSE: Recent population-level increases in intravenous drug abuse (IVDA) may contribute to the incidence of spinal infection. The purpose of this study is to evaluate national trends of operative spinal infections and evaluate the effect of IVDA on outcomes in the operative management of spinal infection.
METHODS: Utilizing the National/Nationwide Inpatient Sample database from 2002 to 2014, all patients undergoing spinal decompression and/or fusion for the treatment of spinal infection were evaluated. Inpatient outcomes included length of stay, total cost, complications, discharge to facility, reoperations, and inpatient mortality. Bivariate and multivariate logistic regression analyses were performed to compare IVDA patients and non-IVDA patients.
RESULTS: In total, 60,964 patients undergoing surgical management of spinal infection were identified. The total number of surgically-managed spine infections increased from 2002 to 2014 (p<0.0001). The proportion of surgically-managed spine infections associated with IVDA increased from 3.3% in 2002 to 14.0% in 2014 (p<0.0001). IVDU was associated with increased hospital length of stay [LOS] (OR 1.38, 95% CI 1.32-1.45, p<.0001) and greater total charges (OR 1.23, 95% CI 1.17-1.29, p<.0001). No other significant differences between groups were noted.
CONCLUSION: From 2002-2014 in the United States, the incidence of operatively-treated spine infections increased 227.9%, and the proportion of cases associated with IVDA significantly increased. Intravenous drug abusers (IVDAs) had a longer mean LOS and increased inpatient cost of care, but were not at increased risk for complication, reoperation, or mortality. These findings are important for surgeons, internists, hospitals, and insurers to ensure proper resource allocation in treating these at-risk patients.
PMID: 30639488 [PubMed - as supplied by publisher]