The conundrum of finding an optimal spondylodiscitis treatment pathway: how do treatments affect readmission rates?

Abstract

The rising incidence of spondylodiscitis (SD) poses a challenge to healthcare systems worldwide. Treatment approaches are inconsistent, devoid of standardized algorithms and lack evidence-based guidelines. To date there is a knowledge gap relative to treatment, readmission rates and efficacy for different SD management strategies. This study aims to assess the 90-day all-cause readmission rates for SD relative to treatment pathways. Using the 2020 Nationwide Readmissions Database we screened adult patients (> 18 years) for primary diagnosis of SD by ICD-10 Codes. Demographic/clinical data, and treatments was extracted. The cohort was divided into two groups by treatment at initial admission. Descriptive and comparative analysis, with a multivariate regression to identify independent risk factors for readmission, were performed. Out of 6,139 patients, 1,258 patients (20.5%) receiving surgical treatment. The overall, readmission rate was 35%. Surgically treated patients had a significantly lower readmission rate and a shorter time to readmission (29.3%; 41.65 days (± 22.84)). Those receiving surgical care during both stays (0.8%) had the longest time to readmission at 50.85 days (± 24.27). A change in treatment upon readmission was observed in 8.4%. Surgical management at index admission was identified as a protective factor against readmission. SD management remains challenging. We showed that primary surgical treatment of SD resulted in a significantly lower readmission rate with a longer time interval until readmission compared to non-surgically treatment. Surgery at initial admission was identified as a protective factors against readmission. A more definitive initial approach towards SD might lower unexpected readmissions.