Spinal epidural abscess: Does social deprivation influence 1-year mortality?

Background

Spinal epidural abscess are difficult to diagnose due to its non-specific clinical presentation. Spinal epidural abscess is identified late or missed in almost half of patients. To better assist clinicians in making this diagnosis there needs to be a better appreciation of at risk patient profile.

Methods

We identified all patients who were admitted to a tertiary referral centre with a diagnosis of spinal epidural abscess between February 2009 and January 2022. Demographic details, presentation details, past medical history, concurrent infection, and social factors were recorded for all patients. The primary aim of our study was to examine if there is a relationship between social deprivation and risk of mortality at one year in patients with spinal epidural abscess.

Results

There were 140 eligible patients associated with 146 hospital encounters for spinal epidural abscess. Eighteen patients died at ≤365 days post discharge, while 122 patients were alive at >365 days post discharge. There were 86 males and 54 females. The average age was 59.9 years with an IQR of 19.3. There were 28 % Māori, 58 % European and 12 % of all other ethnicities. In the most deprived quantile there were 34.5 %, compared to 7.5 % in the least deprived quantile.

Multivariate stepwise regression analysis found that age, mean neutrophil count and congestive heart failure all showed a statistically significance association with mortality at one year. There was no association between one year mortality and these variables: deprivation status, rurality or Māori ethnicity.

Conclusion

Mortality at one year appears to be significantly associated with age, mean neutrophil count and congestive heart failure. There was no obvious association between deprivation and mortality at one year. Identifying patients at the greatest risk of mortality remains a complex challenge.