Early decompressive surgery within 72 hours of admission maintains financial advantages for patients with spinal epidural abscess, as evidenced by a retrospective study involving 130 cases
Authors: Yang Min-Jie , Wang Hao-Kuang 
Published: September 2023

Abstract

Background
Several recent studies have highlighted the advantages of early decompressive surgery for patients with spinal epidural abscesses, specifically in terms of neurological function and overall quality of life. However, these studies predominantly advocate for surgery within 24 hours of admission, a time frame that may prove challenging for many hospitals because of limited operating room availability and bed occupancy. Consequently, it is pertinent to investigate whether a more flexible definition of “early surgery” yields observable benefits for patients to address these practical constraints.

Materials and Methods
In this 10-year retrospective study, we analyzed the electronic medical records of 130 patients who underwent decompressive surgery for epidural abscess. Patients were categorized into three groups based on the time intervals between admission and surgery: ≤24 hours (n = 24), 24 to 72 hours (n = 26), and >72 hours (n = 80). Comparative assessments of demographic data, clinical presentations, and preoperative imaging characteristics revealed no statistically significant differences. We conducted separate analyses at 24 hours (n = 24 vs n = 106) and 72 hours (n = 50 vs n = 80) to explore the effects of different cutoff times. Neurological improvement (American Spinal Injury Association Impairment Scale [AIS] grade), daily living function (modified Prolo scale) changes 6 months postdischarge, and financial burden (hospitalization and postoperative stay duration, total expenditure) were evaluated as outcome measures. In addition, we compared the outcomes of patients within the 24- to 72-hour time range with those in the ≤24- and >72-hour group to determine any differences among the three groups.

Results
Significant changes in AIS grade (1.17 vs 0.66, P = 0.019) and modified Prolo scale (4.21 vs 2.90, P = 0.011) were observed in the 24-hour group, whereas no such changes were seen in the 72-hour group. However, both groups showed reductions in financial burden, including hospitalization duration (24-hour group: 27.8 vs 46.8 days, P < 0.001; 72-hour group: 31.3 vs 50.7 days, P < 0.001) and total cost (24-hour group: $6551 vs $11,024, P < 0.001; 72-hour group: $6709 vs $12,406, P < 0.001). When analyzing the subgroup of patients with a time interval between 24 and 72 hours, we observed a loss of beneficial effects on AIS grade changes (1.2 vs 0.6, P = 0.045) and modified Prolo scale improvement (4.2 vs 3.1, P = 0.044) compared with the ≤24-hour group. However, this subgroup still exhibited positive effects in terms of reduced financial burden, including hospitalization duration (34.6 vs 50.7 days, P = 0.002) and total cost ($6851 vs $12,406, P < 0.001), when compared with the >72-hour group.

Conclusions
Our findings indicate that delaying decompressive surgery up to 72 hours after admission negates its benefits in enhancing neurological recovery and restoring daily life capacity. Nonetheless, this surgical approach continues to provide financial advantages by alleviating the financial burden on patients and the health care system. Further research with a larger sample size is recommended to deepen our understanding of these advantages.