Long-term rates of bladder dysfunction after decompression in patients with cauda equina syndrome |
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| Authors: | Henry Seidel Sarah Bhattacharjee Sean Pirkle Lewis Shi Jason Strelzow Michael Lee Mostafa El Dafrawy |
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| Affiliation: | 1. Pritzker School of Medicine at The University of Chicago, 924 E. 57th St, Suite 104, Chicago, IL 60637, USA;2. The University of Chicago, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Hospitals, Duchossois Center for Advanced Medicine, MC 3079, 5758 S. Maryland Avenue, Dept 4B, Chicago, IL 60637, USA;1. Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (UBC), Vancouver, Canada;2. Great Ormond Street Hospital, London, United Kingdom;3. Department of Anesthesia, British Columbia Children''s Hospital, Vancouver, Canada;4. Research Institute, BC Children''s Hospital, Vancouver, Canada;1. Division of Neurosurgery, AOU Sant''Andrea, Department of NESMOS, Sapienza University, Rome, Italy;2. Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, University of Rome, Italy;1. Department of Neurological Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA;2. Department of Orthopedic Surgery, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA;3. Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, 5151 Harry Hines Blvd, Dallas, TX 75235 USA;1. Loyola University Chicago, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL 60153, Ph: +1 213-268-3030;2. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, Ph: +1 949-521-3086;3. Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California,1500 San Pablo Street, Los Angeles, CA 90033;4. USC Spine Center, Keck Medical Center of University of Southern California, 1420 San Pablo Street, Ste 5400, Los Angeles, CA 90033;1. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA;2. Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX;3. Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, the Netherlands, 3584 CX;4. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA |
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| Abstract: | BACKGROUND CONTEXTCauda equina syndrome (CES) occurs due to compression of the lumbar and sacral nerve roots and is considered a surgical emergency. Although the condition is relatively rare, the associated morbidity can be devastating to patients. While substantial research has been conducted on the timing of treatment, the literature regarding long-term rates of bladder dysfunction in CES patients is scarce.PURPOSEThe aim of this study was to identify long-term rates of bladder dysfunction in CES patients and to compare those rates to non-CES patients who underwent similar spinal decompression.STUDY DESIGN/SETTINGRetrospective database study.PATIENT SAMPLEThe CES cohort was comprised of 2,362 patients who underwent decompression surgery following CES diagnosis with a 5-year follow-up. These patients were matched to 9,448 non-CES control patients who underwent spinal decompression without a diagnosis of CES.OUTCOME MEASURESDiagnosis of bladder dysfunction, surgical procedure to address bladder dysfunctionMETHODSUsing the national insurance claims database, PearlDiver, CES patients who underwent decompression surgery were identified and 1:4 matched to non-CES patients who underwent similar spinal decompression surgery. The 1-year, 3-year, and 5-year rates of progression to a bladder dysfunction diagnosis and surgical intervention to manage bladder dysfunction were recorded. The CES and non-CES groups were compared with univariate testing, and an analysis of risk factors for bladder dysfunction was performed with multivariate logistic regression analysis.RESULTSA total of 2,362 CES patients who underwent decompression surgery were identified and matched to 9,448 non-CES control patients. After 5 years, CES patients had a 10%–12% increased absolute risk of continued bladder dysfunction and a 0.7%–0.9% increased absolute risk of undergoing a surgical procedure for bladder dysfunction, as compared to matched non-CES patients. Multivariate analysis controlling for age, sex, obesity, tobacco use, and diabetes, identified CES as independently associated with increased 5-year risk for bladder dysfunction diagnosis (odds ratio [OR]: 1.72; 95% confidence interaval [CI] 1.56–1.89; p<.001) and procedure (OR: 1.40; 95% CI 1.07–1.81; p=.012).CONCLUSIONSUnderstanding the long-term risk for bladder dysfunction in CES patients is important for the future care and counseling of patients. Compared to non-CES patients who underwent similar spinal decompression, CES patients were observed to have a significantly higher long-term likelihood for both bladder dysfunction diagnosis and urologic surgical procedure. |
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