{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:49:42Z","timestamp":1791236982881,"version":"4.1.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Pyogenic spondylodiscitis is a severe spinal infection often requiring surgical intervention, with notable one-year mortality rates. This study aimed to identify factors associated with 1-year mortality following instrumented surgery to guide postoperative care and surgical planning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 370 patients who underwent instrumented surgery for pyogenic spondylodiscitis (2013\u20132022). Univariate and multivariate logistic regression analyzed factors associated with 1-year-mortality, including age, Charlson Comorbidity Index (CCI), neurological deficits, C-reactive protein levels (CRP), type of surgery, number of spinal levels treated, complications, duration of surgery, and revision surgery. ROC analysis determined optimal cutoff values for significant factors associated with mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of the 370 patients included in the study, 38 (10.2%) died within one year of treatment, including 6 (1.6%) within the first 30 days. The mean follow-up period was 24\u2009\u00b1\u20093 months. Univariate analysis identified the presence of neurological deficits (OR 2.82, 95% CI 1.21\u20136.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0158), last CRP levels (OR 1.009, 95% CI 1.005\u20131.014,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and the number of spinal levels treated (OR 1.35, 95% CI 1.03\u20131.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0294) as significant factors associated with 1-year mortality. Multivariate logistic regression confirmed last CRP (OR 1.01, 95% CI 1.004\u20131.016,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and number of spinal levels treated (OR 1.345, 95% CI 1.006\u20131.799,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046) as independent factors associated with mortality within one year. Receiver operating characteristic (ROC) analysis identified optimal thresholds for predicting mortality: last CRP\u2009&gt;\u200947\u00a0mg\/L (AUC 0.767) and more than two spinal levels treated (AUC 0.638).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated CRP levels(&gt;\u200947\u00a0mg\/L) at a median of 4 months postoperatively [IQR: 2\u20136], and extensive spinal surgery involving more than two levels are independent factors associated with one-year mortality. These findings highlight the importance of long-term postoperative CRP monitoring and careful surgical planning to improve outcomes in patients with pyogenic spondylodiscitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10143-025-04114-8","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T23:51:53Z","timestamp":1769212313000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prediction and risk factors for one year mortality in patients after surgery for pyogenic spondylodiscitis"],"prefix":"10.1007","volume":"49","author":[{"given":"B.","family":"Younes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Schatlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Mielke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Rohde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Abboud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"4114_CR1","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3109\/23744235.2015.1103897","volume":"48","author":"T Aagaard","year":"2016","unstructured":"Aagaard T, Roed C, Dahl B, Obel N (2016) Long-term prognosis and causes of death after spondylodiscitis: a Danish nationwide cohort study. Infect Dis 48:201\u2013208. https:\/\/doi.org\/10.3109\/23744235.2015.1103897","journal-title":"Infect Dis"},{"key":"4114_CR2","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.1136\/bmjopen-2012","volume":"3","author":"T Akiyama","year":"2013","unstructured":"Akiyama T, Chikuda H, Yasunaga H, Horiguchi H, Fushimi K, Saita K (2013) Incidence and risk factors for mortality of vertebral osteomyelitis: a retrospective analysis using the Japanese diagnosis procedure combination database. Open 3:2412. https:\/\/doi.org\/10.1136\/bmjopen-2012","journal-title":"Open"},{"key":"4114_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2020.5.FOCUS20267","volume":"49","author":"C Bettag","year":"2020","unstructured":"Bettag C, Abboud T, von der Brelie C, Melich P, Rohde V, Schatlo B (2020) Do we underdiagnose osteoporosis in patients with pyogenic spondylodiscitis? Neurosurg Focus 49:1\u20136. https:\/\/doi.org\/10.3171\/2020.5.FOCUS20267","journal-title":"Neurosurg Focus"},{"key":"4114_CR4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.5455\/medarh.2019.73.39-43","volume":"73","author":"EM Bonura","year":"2019","unstructured":"Bonura EM, Morales DJO, Fenga D, Rollo G, Meccariello L, Leonetti D, Traina F, Centofanti F, Rosa MA (2019) Conservative treatment of spondylodiscitis: possible therapeutic solution in case of failure of standard therapy. Med Arch 73:39\u201343. https:\/\/doi.org\/10.5455\/medarh.2019.73.39-43","journal-title":"Med Arch"},{"key":"4114_CR5","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jcot.2021.03.013","volume":"15","author":"M Elmajee","year":"2021","unstructured":"Elmajee M, Munasinghe C, Aljawadi A, Elawady K, Shuweihde F, Pillai A (2021) Posterior stabilisation without formal debridement for the treatment of non-tuberculous pyogenic spinal infection in frail and debilitated population \u2013 a systematic review and meta-analysis. J Clin Orthop Trauma 15:9\u201315. https:\/\/doi.org\/10.1016\/j.jcot.2021.03.013","journal-title":"J Clin Orthop Trauma"},{"key":"4114_CR6","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofu107","author":"A Gupta","year":"2014","unstructured":"Gupta A, Kowalski TJ, Osmon DR, Enzler M, Steckelberg JM, Huddleston PM, Nassr A, Mandrekar JM, Berbari EF (2014) Long-term outcome of pyogenic vertebral osteomyelitis: a cohort study of 260 patients. Open Forum Infect Dis. https:\/\/doi.org\/10.1093\/ofid\/ofu107","journal-title":"Open Forum Infect Dis"},{"key":"4114_CR7","doi-asserted-by":"publisher","first-page":"591","DOI":"10.14444\/8080","volume":"15","author":"GA Hasan","year":"2021","unstructured":"Hasan GA, Raheem HQ, Qutub A, Wais YB, Katran MH, Shetty GM (2021) Management of pyogenic spondylodiscitis following nonspinal surgeries: a tertiary care center experience. Int J Spine Surg 15:591\u2013599. https:\/\/doi.org\/10.14444\/8080","journal-title":"Int J Spine Surg"},{"key":"4114_CR8","doi-asserted-by":"publisher","unstructured":"Jin Y, Liu A, Overbey JR, Medikonda R, Feghali J, Krishnan S, Ishida W, Pairojboriboon S, Gokaslan ZL, Wolinsky JP, Theodore N, Bydon A, Sciubba DM, Witham TF, Lo SFL (2022) Risk factors for surgical intervention in patients with primary spinal infection on initial presentation. J Neurosurg: spine. American Association of Neurological Surgeons, pp 283\u2013291. https:\/\/doi.org\/10.3171\/2022.1.SPINE211527","DOI":"10.3171\/2022.1.SPINE211527"},{"key":"4114_CR9","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12237228","author":"AK Joerger","year":"2023","unstructured":"Joerger AK, Albrecht C, Lange N, Meyer B, Wostrack M (2023) In-hospital mortality from spondylodiscitis: insights from a single-center retrospective study. J Clin Med. https:\/\/doi.org\/10.3390\/jcm12237228","journal-title":"J Clin Med"},{"key":"4114_CR10","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1016\/j.spinee.2015.02.021","volume":"15","author":"M Kehrer","year":"2015","unstructured":"Kehrer M, Pedersen C, Jensen TG, Hallas J, Lassen AT (2015) Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population. Spine J 15:1233\u20131240. https:\/\/doi.org\/10.1016\/j.spinee.2015.02.021","journal-title":"Spine J"},{"key":"4114_CR11","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-47341-z","author":"A Kramer","year":"2023","unstructured":"Kramer A, Thavarajasingam SG, Neuhoff J, Ponniah HS, Ramsay DSC, Demetriades AK, Davies BM, Shiban E, Ringel F (2023) Epidemiological trends of pyogenic spondylodiscitis in Germany: an EANS spine section study. Sci Rep. https:\/\/doi.org\/10.1038\/s41598-023-47341-z","journal-title":"Sci Rep"},{"key":"4114_CR12","doi-asserted-by":"publisher","first-page":"4745","DOI":"10.1007\/s00068-022-02001-1","volume":"48","author":"M Kreutztr\u00e4ger","year":"2022","unstructured":"Kreutztr\u00e4ger M, L\u00fcbstorf T, Ekkernkamp A, Blex C, Schwab JM, Kopp MA, Auhuber T, W\u00fcstner G, Liebscher T (2022) Spinal infection with intraspinal abscess or empyema and acute myelopathy: comparative analysis of diagnostics, therapy, complications and outcome in primary care. Eur J Trauma Emerg Surg 48:4745\u20134754. https:\/\/doi.org\/10.1007\/s00068-022-02001-1","journal-title":"Eur J Trauma Emerg Surg"},{"key":"4114_CR13","doi-asserted-by":"publisher","first-page":"e663","DOI":"10.1016\/j.wneu.2023.02.128","volume":"173","author":"A Lawson McLean","year":"2023","unstructured":"Lawson McLean A, Senft C, Schwarz F (2023) Management of lumbar pyogenic spondylodiscitis in Germany: a cross-sectional analysis of spine specialists. World Neurosurg 173:e663\u2013e668. https:\/\/doi.org\/10.1016\/j.wneu.2023.02.128","journal-title":"World Neurosurg"},{"key":"4114_CR14","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1016\/j.spinee.2021.12.015","volume":"22","author":"S Lener","year":"2022","unstructured":"Lener S, Wipplinger C, Lang A, Hartmann S, Abramovic A, Thom\u00e9 C (2022) A scoring system for the preoperative evaluation of prognosis in spinal infection: the MSI-20 score. Spine J 22:827\u2013834. https:\/\/doi.org\/10.1016\/j.spinee.2021.12.015","journal-title":"Spine J"},{"key":"4114_CR15","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-020-04507-2","author":"S Lener","year":"2020","unstructured":"Lener S, Wipplinger C, Stocsits A, Hartmann S, Hofer A, Thom\u00e9 C (2020) Early surgery may lower mortality in patients suffering from severe spinal infection. Acta Neurochir. https:\/\/doi.org\/10.1007\/s00701-020-04507-2","journal-title":"Acta Neurochir"},{"key":"4114_CR16","doi-asserted-by":"publisher","first-page":"3175","DOI":"10.1007\/s00586-024-08250-5","volume":"33","author":"KS Maddy","year":"2024","unstructured":"Maddy KS, Tigre JY, Lu VM, Costello MC, Errante EL, Levi AD, Burks SS (2024) Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: a systematic review and meta-analysis. Eur Spine J 33:3175\u20133190. https:\/\/doi.org\/10.1007\/s00586-024-08250-5","journal-title":"Eur Spine J"},{"key":"4114_CR17","doi-asserted-by":"publisher","first-page":"989","DOI":"10.14444\/7148","volume":"14","author":"K Nagata","year":"2020","unstructured":"Nagata K, Ando T, Sasaki K, Urayama D (2020) Skipping pedicle screw insertion into infected vertebra is a risk factor for revision surgery for pyogenic spondylitis in the lower thoracic and lumbar spine. Int J Spine Surg 14:989\u2013995. https:\/\/doi.org\/10.14444\/7148","journal-title":"Int J Spine Surg"},{"key":"4114_CR18","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2023.102721","author":"J Neuhoff","year":"2024","unstructured":"Neuhoff J, Berkulian O, Kramer A, Thavarajasingam S, Wengert A, Schleicher P, Pingel A, Kandziora F (2024) Single- and multilevel corpectomy and vertebral body replacement for treatment of spinal infections. A retrospective single-center study of 100 cases. Brain and Spine. https:\/\/doi.org\/10.1016\/j.bas.2023.102721","journal-title":"Brain and Spine"},{"key":"4114_CR19","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000003223","author":"J Neuhoff","year":"2024","unstructured":"Neuhoff J, Kramer A, Thavarajasingam SG, Sutherland RK, Mccaughan H, Joerger AK, Wostrack M, Lyell B, Berkulian O, Ponniah HS, Ramsay DSC, Meyer B, Kandziora F, Shiban E, Davies B, Demetriades AK, Ringel F (2024) Comparing conservative and early surgical treatments for pyogenic spondylodiskitis: an international propensity score-matched retrospective outcome analysis. Neurosurgery. https:\/\/doi.org\/10.1227\/neu.0000000000003223","journal-title":"Neurosurgery"},{"key":"4114_CR20","doi-asserted-by":"publisher","first-page":"396","DOI":"10.3171\/2022.11.SPINE22719","volume":"38","author":"J Pluemer","year":"2023","unstructured":"Pluemer J, Freyvert Y, Pratt N, Robinson JE, Cooke JA, Tataryn ZL, Pierre CA, Godolias P, Frieler S, von Glinski A, Yilmaz E, Daher ZA, Al-Awadi HA, Young MH, Oskouian RJ, Chapman JR (2023) A novel scoring system concept for de novo spinal infection treatment, the spinal infection treatment evaluation score (SITE score): a proof-of-concept study. J Neurosurg Spine 38:396\u2013404. https:\/\/doi.org\/10.3171\/2022.11.SPINE22719","journal-title":"J Neurosurg Spine"},{"key":"4114_CR21","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1007\/s00586-016-4685-z","volume":"25","author":"JPHJ Rutges","year":"2016","unstructured":"Rutges JPHJ, Kempen DH, van Dijk M, Oner FC (2016) Outcome of conservative and surgical treatment of pyogenic spondylodiscitis: a systematic literature review. Eur Spine J 25:983\u2013999. https:\/\/doi.org\/10.1007\/s00586-016-4685-z","journal-title":"Eur Spine J"},{"key":"4114_CR22","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1055\/a-1832-9092","volume":"84","author":"B Schatlo","year":"2023","unstructured":"Schatlo B, Rohde V, Abboud T, Janssen I, Melich P, Meyer B, Shiban E (2023) The role of diskectomy in reducing infectious complications after surgery for lumbar spondylodiscitis. J Neurol Surg A Cent Eur Neurosurg 84:3\u20137. https:\/\/doi.org\/10.1055\/a-1832-9092","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"4114_CR23","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1007\/s00586-022-07157-3","volume":"31","author":"F Sch\u00f6mig","year":"2022","unstructured":"Sch\u00f6mig F, Li Z, Perka L, Vu-Han TL, Diekhoff T, Fisher CG, Pumberger M (2022) Georg schmorl prize of the German spine society (DWG) 2021: spinal instability spondylodiscitis score (SISS)\u2014a novel classification system for spinal instability in spontaneous spondylodiscitis. Eur Spine J 31:1099\u20131106. https:\/\/doi.org\/10.1007\/s00586-022-07157-3","journal-title":"Eur Spine J"},{"key":"4114_CR24","doi-asserted-by":"publisher","DOI":"10.1016\/j.bas.2023.101733","author":"SG Thavarajasingam","year":"2023","unstructured":"Thavarajasingam SG, Subbiah Ponniah H, Philipps R, Neuhoff J, Kramer A, Demetriades AK, Shiban E, Ringel F, Davies B (2023) Increasing incidence of spondylodiscitis in England: an analysis of the national health service (NHS) hospital episode statistics from 2012 to 2021. Brain and Spine. https:\/\/doi.org\/10.1016\/j.bas.2023.101733","journal-title":"Brain and Spine"},{"key":"4114_CR25","doi-asserted-by":"publisher","unstructured":"Thavarajasingam SG, Vemulapalli KV, Vishnu KS, Ponniah HS, Vogel ASM, Vardanyan R, Neuhoff J, Kramer A, Shiban E, Ringel F, Demetriades AK, Davies BM (2023) Conservative versus early surgical treatment in the management of pyogenic spondylodiscitis: a systematic review and meta-analysis. Sci Rep 13. https:\/\/doi.org\/10.1038\/s41598-023-41381-1","DOI":"10.1038\/s41598-023-41381-1"},{"key":"4114_CR26","doi-asserted-by":"publisher","first-page":"608","DOI":"10.31616\/asj.2018.0295","volume":"13","author":"J Vettivel","year":"2019","unstructured":"Vettivel J, Bortz C, Passias PG, Baker JF (2019) Pyogenic vertebral column osteomyelitis in adults: analysis of risk factors for 30-day and 1-year mortality in a single center cohort study. Asian Spine J 13:608\u2013614. https:\/\/doi.org\/10.31616\/asj.2018.0295","journal-title":"Asian Spine J"},{"key":"4114_CR27","doi-asserted-by":"publisher","first-page":"e297","DOI":"10.1016\/j.wneu.2018.08.055","volume":"120","author":"NH von der Hoeh","year":"2018","unstructured":"von der Hoeh NH, Voelker A, Hofmann A, Zajonz D, Spiegl UA, Jarvers JS, Heyde CE (2018) Pyogenic spondylodiscitis of the thoracic spine: outcome of 1-stage posterior versus 2-stage posterior and anterior spinal reconstruction in adults. World Neurosurg 120:e297\u2013e303. https:\/\/doi.org\/10.1016\/j.wneu.2018.08.055","journal-title":"World Neurosurg"},{"key":"4114_CR28","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.1007\/s00586-020-06519-z","volume":"30","author":"A Yagdiran","year":"2021","unstructured":"Yagdiran A, Otto-Lambertz C, Lingscheid KM, Sircar K, Samel C, Scheyerer MJ, Zarghooni K, Eysel P, Sobottke R, Jung N, Siewe J (2021) Quality of life and mortality after surgical treatment for vertebral osteomyelitis (VO): a prospective study. Eur Spine J 30:1721\u20131731. https:\/\/doi.org\/10.1007\/s00586-020-06519-z","journal-title":"Eur Spine J"},{"key":"4114_CR29","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s00264-011-1426-0","volume":"36","author":"K Zarghooni","year":"2012","unstructured":"Zarghooni K, R\u00f6llinghoff M, Sobottke R, Eysel P (2012) Treatment of spondylodiscitis. Int Orthop 36:405\u2013411. https:\/\/doi.org\/10.1007\/s00264-011-1426-0","journal-title":"Int Orthop"},{"key":"4114_CR30","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12144805","author":"TP Ziarko","year":"2023","unstructured":"Ziarko TP, Walter N, Schindler M, Alt V, Rupp M, Lang S (2023) Risk factors for the in-hospital mortality in pyogenic vertebral osteomyelitis: a cross-sectional study on 9753 patients. J Clin Med. https:\/\/doi.org\/10.3390\/jcm12144805","journal-title":"J Clin Med"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-04114-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-025-04114-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-04114-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T05:29:02Z","timestamp":1777699742000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-025-04114-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,24]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4114"],"URL":"https:\/\/doi.org\/10.1007\/s10143-025-04114-8","relation":{},"ISSN":["1437-2320"],"issn-type":[{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,24]]},"assertion":[{"value":"23 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 December 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2026","order":6,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":7,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This article was originally published under the subscription model but it is now published under an Open Access license.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of University Hospital G\u00f6ttingen, application number: 3\/12\/17 approved this study. All procedures adhered to local and institutional laws and data protection regulations. Informed consent was not required as the study was retrospective in nature and involved the analysis of previously collected data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"For this retrospective study, formal consent for publication was not required, as all data were anonymized and collected in accordance with institutional ethical standards and national data protection regulations.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}}],"article-number":"151"}}