| 摘要 |
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 thatmay prove challenging formany hospitals because of limited operating roomavailability
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. |
