COMPARSION OF HOSPITAL MORTALITY AND RISK FACTORS IN CONSERVATIVE AND SURGICAL TREATMENT OF PYOGENIC VERTEBRAL OSTEOMYELITIS: A NATIONALWIDE ANALYSIS OF 49,951 CASES IN GERMANY

Aim The management of pyogenic vertebral osteomyelitis (VO) is a challenging aspect of clinical practice. Choosing between conservative and surgical treatment presents a significant dilemma for both patients and surgeons. Therefore, this study aims to comprehensively evaluate the risk factors associated with hospital mortality in patients undergoing either conservative or surgical treatment. Methods For this study, data from January 2019 to December 2023 were obtained from the database of the German Institute for the Hospital Remuneration System (InEK) GmbH. The analysis was based on German diagnosis-related groups (DRG) to assess demographic data, treatment methods, and accompanying diagnoses using ICD-10 codes (M46.20 to M46.59) and procedures (OPS from 5-838.g to 5-838.y and 5-83b.00 to 5-83b.y). Differences between conservative and surgical treatment were evaluated using the chi-square test, while odds ratios (OR) were calculated to identify potential risk factors for hospital mortality. Results In Germany, 49,951 hospital admissions for VO were recorded. Diagnoses were distributed as follows: 27.1% in ages 18–64 (n=13,528), 72.3% in ≥65 (n=36,118), and 30.6% in ≥80 (n=15,299). Most patients were male (61%, n=30,444). Lumbar VO was most common (56.4%, n=28,192), followed by thoracic VO (18.3%, n=9,124). Treatment was conservative in 62.9% and surgical in 37.1%. Hospital mortality was higher in surgically treated patients aged ≥65 (OR 1.66 vs. 0.75; p<0.001) and ≥80 (OR 1.89 vs. 0.75; p<0.001). In conservatively managed VO with intraspinal abscess, mortality risk increased (OR 1.9; p<0.001). Conclusion This study offers valuable insights into the current nationwide management of VO in Germany and the risk factors influencing hospital mortality in both conservative and surgical treatments. The results highlight the importance of thorough risk assessment and personalized treatment approaches, particularly for geriatric patients.