{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T13:11:10Z","timestamp":1785503470212,"version":"3.56.0"},"reference-count":44,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Registry-based retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Identify risk factors for in-hospital mortality in patients with vertebral osteomyelitis (VO) treated conservatively or surgically using a national dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Hospital data from 2019 to 2023 were analyzed using the database of the German Institute for the Hospital Remuneration System (InEK). Cases were identified by ICD-10 codes M46.20\u2013M46.59. Diagnosis-related groups (DRG) were used to analyze demographics and treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 49,951 VO cases were identified, with an overall in-hospital mortality of 6.7%. The incidence of VO in Germany from 2020 to 2023 was 46.2 cases per 100,000 population. VO in the cervicothoracic (OR 2.31), thoracolumbar (OR 2.88), lumbosacral (OR 2.60) and multifocal (OR 3.93) regions was associated with increased in-hospital mortality. Conservative treatment was linked to higher mortality in intraspinal abscesses (OR 1.9) and multifocal disease (OR 2.29). In unadjusted, treatment-stratified analyses, surgical treatment was associated with higher in-hospital mortality in patients aged \u226565 years (OR 1.47) and \u226580 years (OR 1.56). Regarding pathogens, the highest mortality ORs were observed in patients infected with\n                      <jats:italic toggle=\"yes\">Bacteroides fragilis and other anaerobic gram-negative bacteria<\/jats:italic>\n                      (OR 2.81, conservative treatment) as well as\n                      <jats:italic toggle=\"yes\">Haemophilus influenzae<\/jats:italic>\n                      (OR 2.00, surgical treatment). In the pooled risk-factor analysis,\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      carried the highest pathogen-associated in-hospital death (OR 2.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This nationwide analysis identifies factors associated for in-hospital mortality in VO. Conservative management, though most common, carries increased risk in high-risk settings such as epidural abscesses or multifocal disease. In unadjusted analyses, surgical treatment in elderly patients was associated with higher in-hospital mortality. Because treatment was not randomly allocated and surgical patients differ systematically in disease severity, this association is likely confounded by indication and cannot be read as a treatment effect. Findings underscore the need for individualized, risk-adapted strategies and for adjusted, longitudinal studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261474479","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T21:50:13Z","timestamp":1785361813000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of Hospital Mortality and Risk Factors in Conservative and Surgical Treatment of Pyogenic Vertebral Osteomyelitis: A Nationwide Analysis of 49,951 Cases in Germany"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5050-0316","authenticated-orcid":false,"given":"Melanie","family":"Ardelt","sequence":"first","affiliation":[{"name":"Danube University Krems"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josina","family":"Straub","sequence":"additional","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3057-2600","authenticated-orcid":false,"given":"Jonas","family":"Kr\u00fcckel","sequence":"additional","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Palacio","family":"Giraldo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Rupp","sequence":"additional","affiliation":[{"name":"University Hospital Giessen"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Loibl","sequence":"additional","affiliation":[{"name":"Schulthess Klinik"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Alt","sequence":"additional","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dietmar","family":"Dammerer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0459-9092","authenticated-orcid":false,"given":"Siegmund","family":"Lang","sequence":"additional","affiliation":[{"name":"University Hospital Regensburg"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkq303"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1302\/2046-3758.1011.BJR-2021-0371"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp0910753"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00113-021-01002-w"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000201172.64764.bb"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/BSD.0000000000000597"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-47341-z"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12103373"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2024.1357318"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s10195-023-00711-9"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-023-04783-4"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-10316-0"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682221121300"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12144805"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-023-07616-5"},{"key":"e_1_3_5_17_2","volume-title":"International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification","year":"2024","unstructured":"International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification, Version; 2024."},{"key":"e_1_3_5_18_2","unstructured":"The Institute for the Remuneration System in Hospitals (InEK) data browser."},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268821002181"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2025.111183"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12237228"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11030660"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.1615\/JLongTermEffMedImplants.2023049402"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-022-07157-3"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-018-3467-2"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-79012-8"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.2.160062"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-013-2850-1"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61233-2"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06703-4"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/21925682231194467"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2023.02.128"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1086\/340102"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-015-4318-y"},{"key":"e_1_3_5_35_2","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000003223"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-024-06247-9"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31816b8872"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/bmb\/ldw003"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.4103\/jcvjs.JCVJS_115_18"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-018-5775-x"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2021.12.015"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-023-02003-6"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1177\/2192568219862213"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-41381-1"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2024.12.018"}],"container-title":["Global Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261474479","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21925682261474479","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21925682261474479","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:46:47Z","timestamp":1785502007000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21925682261474479"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":44,"alternative-id":["10.1177\/21925682261474479"],"URL":"https:\/\/doi.org\/10.1177\/21925682261474479","relation":{},"ISSN":["2192-5682","2192-5690"],"issn-type":[{"value":"2192-5682","type":"print"},{"value":"2192-5690","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"article-number":"21925682261474479"}}