{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T11:02:06Z","timestamp":1771498926134,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Unplanned hospital readmission after surgical treatment of primary spinal infections (PSIs) represents a major clinical and economic burden. Despite the fact that advances in surgical and antimicrobial management have been made, risk stratification for early and late readmissions remains poorly defined. Objective: We aimed to explore the clinical, microbiological, and perioperative characteristics potentially associated with 30-day, 90-day, and 1-year unplanned readmissions following the surgical treatment of PSIs in adult patients. Methods: A retrospective cohort study was performed that included adult patients who underwent surgery for primary spinal infections between January 2017 and December 2023 at our tertiary referral center. Demographics, comorbidities, laboratory parameters, microbiological profiles, and postoperative outcomes were analyzed. Associations between candidate variables and readmission were explored using univariate statistical analyses; multivariable modeling was not performed due to the low number of readmission events. Results: In total, seventy-nine patients (mean age 62.2 \u00b1 12.7 years; 38% female) were included. The in-hospital mortality rate was 5.1%; at 1-year follow-up, 10.3% of patients were readmitted and 5.9% required reoperation; and Staphylococcus aureus was the most common isolated pathogen. No independent variables demonstrated a statistically significant association with readmission. However, trends toward higher readmission were observed in patients with liver disease, hypoalbuminemia, and postoperative transfusion. Conclusions: In this exploratory single-center cohort, the low number of readmission events limited statistical power and precluded adjusted modeling. Univariate analyses did not identify statistically significant associations between the evaluated variables and 30-day, 90-day, or 1-year readmission; therefore, the results should be interpreted cautiously as hypothesis-generating. Larger prospective multicenter studies with adequate event counts are needed to support adjusted risk stratification approaches. Until such tools are available, close postoperative follow-up across all PSI patients is necessary.<\/jats:p>","DOI":"10.3390\/jcm15041600","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T08:51:09Z","timestamp":1771491069000},"page":"1600","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploratory Analysis of Factors Affecting 30-Day, 90-Day, and 1-Year Readmission After Surgical Treatment of Primary Spinal Infection in Adults"],"prefix":"10.3390","volume":"15","author":[{"given":"Ismail Ertan","family":"Sevin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3355-8954","authenticated-orcid":false,"given":"Selin","family":"Bozdag","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5797-2335","authenticated-orcid":false,"given":"Onur Davut","family":"Dag","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0193-9439","authenticated-orcid":false,"given":"Ibrahim Eralp","family":"Sevin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9771-0929","authenticated-orcid":false,"given":"Pelin","family":"Pugar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tuna","family":"Demirdal","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-9049","authenticated-orcid":false,"given":"Hasan Kamil","family":"Sucu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip \u00c7elebi University, 35360 Karaba\u011flar, Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"ref_1","unstructured":"Halalmeh, D.R., and Moisi, M. (2024). Diskitis and Vertebral Osteomyelitis of the Spine. Osteomyelitis and Discitis of the Spine: A Guide for the Management of Infectious Etiology of the Vertebral Column and Neurological Components, Elsevier."},{"key":"ref_2","first-page":"e22.00178","article-title":"Primary Spinal Infections in Patients with Hematologic Immunocompromising Conditions: A Systematic Literature Review","volume":"7","author":"Beyer","year":"2023","journal-title":"J. Am. Acad. Orthop. Surg. Glob. Res. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.mric.2024.02.002","article-title":"Infectious Diseases of the Brain and Spine: Parasitic and Other Atypical Transmissible Diseases","volume":"32","author":"Lakhani","year":"2024","journal-title":"Magn. Reason. Imaging Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"Case22157","DOI":"10.3171\/CASE22157","article-title":"Primary spinal infections in patients with solid organ transplant: A systematic literature review and illustrative case","volume":"3","author":"Hatter","year":"2022","journal-title":"J. Neurosurg. Case Lessons"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.rce.2012.03.016","article-title":"Mycobacterium tuberculosis as etiological agent of adult infectious spondylodiscitis","volume":"212","author":"Corti","year":"2012","journal-title":"Rev. Clin. Esp."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00402-006-0114-9","article-title":"Surgical treatment with spinal instrumentation for pyogenic spondylodiscitis due to methicillin-resistant Staphylococcus aureus (MRSA): A report of five cases","volume":"126","author":"Masuda","year":"2006","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_7","first-page":"100293","article-title":"Surgical strategies for spinal infections: A narrative review","volume":"16","author":"Campbell","year":"2023","journal-title":"N. Am. Spine Soc. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e627","DOI":"10.1016\/j.wneu.2017.11.057","article-title":"Risk Factors Associated with Readmission and Reoperation in Patients Undergoing Spine Surgery","volume":"110","author":"Piper","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1007\/s00586-025-08790-4","article-title":"The conundrum of finding an optimal spondylodiscitis treatment pathway: How do treatments affect readmission rates?","volume":"34","author":"Gerstmeyer","year":"2025","journal-title":"Eur. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gerstmeyer, J., Gorbacheva, A., Pierre, C., Kraemer, M., Gold, C., Hogsett, C., Minissale, N., von Glinski, A., Schulte, T.L., and Schildhauer, T.A. (2025). What Is Worse: A Comparison of Solitary Versus Multifocal Pyogenic Spondylodiscitis Using a Nationwide Analysis of Readmission Rates and Risk Factors. J. Clin. Med., 14.","DOI":"10.3390\/jcm14165784"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1093\/biomet\/80.1.27","article-title":"Bias reduction of maximum likelihood estimates","volume":"80","author":"Firth","year":"1993","journal-title":"Biometrika"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.1047","article-title":"A solution to the problem of separation in logistic regression","volume":"21","author":"Heinze","year":"2002","journal-title":"Stat. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1001\/jama.2014.18614","article-title":"Underlying reasons associated with hospital readmission following surgery in the United States","volume":"313","author":"Merkow","year":"2015","journal-title":"Jama"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1007\/s10353-025-00863-4","article-title":"Malnutrition and perioperative nutritional rehabilitation in major operations","volume":"57","author":"Lasithiotakis","year":"2025","journal-title":"Eur. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1038\/sj.bjc.6606087","article-title":"An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: A Glasgow Inflammation Outcome Study","volume":"104","author":"Proctor","year":"2011","journal-title":"Br. J. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1056\/NEJMp1201598","article-title":"Thirty-day readmissions--truth and consequences","volume":"366","author":"Joynt","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1097\/SLA.0b013e31822d7f81","article-title":"The attributable risk of smoking on surgical complications","volume":"254","author":"Hawn","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1161\/CIRCULATIONAHA.107.698977","article-title":"Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery","volume":"116","author":"Murphy","year":"2007","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hung, Y.T., Hung, W.K., and Chi, C.C. (2023). Effects of Preoperative Chronic Steroid Use on Postoperative Outcomes in Orthopedic Surgery: A Systematic Review and Meta-Analysis. Pharmaceuticals, 16.","DOI":"10.3390\/ph16091328"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1038\/sc.2015.234","article-title":"Blood stream infections due to multidrug-resistant organisms among spinal cord-injured patients, epidemiology over 16 years and associated risks: A comparative study","volume":"54","author":"Dinh","year":"2016","journal-title":"Spinal Cord"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/01.BRS.0000109410.46538.74","article-title":"Treatment of pyogenic vertebral osteomyelitis with anterior debridement and fusion followed by delayed posterior spinal fusion","volume":"29","author":"Dimar","year":"2004","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Placide, R., and Reznicek, J. (2025). Evaluation and Management of Pyogenic Spondylodiscitis: A Review. J. Clin. Med., 14.","DOI":"10.3390\/jcm14103477"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"104647","DOI":"10.1016\/j.idnow.2023.01.007","article-title":"2022 SPILF\u2014Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults","volume":"53","author":"Lacasse","year":"2023","journal-title":"Infect. Dis. Now"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and Cox regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_25","first-page":"100083","article-title":"The effect of instrumentation staging on patient outcomes in pyogenic vertebral osteomyelitis: A systematic review","volume":"8","author":"Sanda","year":"2021","journal-title":"N. Am. Spine Soc. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3175","DOI":"10.1007\/s00586-023-08065-w","article-title":"Influence of instrumentation type on outcomes after surgical management of spondylodiscitis: A systematic review and meta-analysis","volume":"33","author":"Maddy","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"128","DOI":"10.21037\/jss.2016.06.06","article-title":"Variables associated with remission in spinal surgical site infections","volume":"2","author":"Faundez","year":"2016","journal-title":"J. Spine Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1600\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T10:02:09Z","timestamp":1771495329000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":27,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041600"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041600","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]}}}