Dissertation
The clinical epidemiology of chronic osteomyelitis: trends, treatment utilization, and outcomes
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2024
DOI: 10.25820/etd.007610
Abstract
Introduction: Despite the substantial impact of chronic osteomyelitis (COM) on patients' quality of life and long-term survival, little is known about its epidemiology and clinical status. The objective of this dissertation is to assess COM trends, treatment utilization, and treatment outcomes.
Methods: We used TriNetX––a large, multi-center, multi-regional database––to investigate all three aims. In the first aim, we investigated overall, regional, and anatomical trends in COM incidence using the Cochran–Armitage test. In the second aim, we examined the relationship between regional, temporal, and patient-level factors and the utilization of COM surgical treatment within a two-week period post-diagnosis using logistic regression models. In the third aim, we estimated the effect of receiving a salvage surgical intervention on the one-year COM treatment outcomes by computing doubly robust inverse probability censoring weighted hazard ratio of treatment failure.
Results: We observed a steady COM incidence over the study period with a slight decline starting in 2020. Also, we found an increasing trend in the incidence of vertebral COM (330.66 to 353.14 per 1000 adult COM patients; P<0.0001). As of 2020, vertebral COM surpassed lower extremity COM as the most common subtype among females. Additionally, we observed an increasing amputations trend (235.6 to 292.1 per 1000 patients with lower or upper extremity COM; P < 0.0001). Amputations and salvage surgical interventions were associated with diabetes, pathogen identification, and CRP levels. Lastly, patients with COM who did not undergo salvage surgical intervention had a higher rate of treatment failure (HR=1.59; 95% CI: 1.52, 1.65; P < 0.0001), mortality (HR=2.71; 95% CI: 2.49, 2.96; P < 0.0001), and amputation (HR=1.98; 95% CI: 1.77, 2.22; P <0.0001).
Conclusion: Robust epidemiological assessments of COM incidence, treatment utilization, and treatment outcomes are vital to reduce the morbidity and mortality associated with this serious condition. Further examinations to understand the changes in overall and vertebral COM trends are needed. Efforts to improve limb salvage treatment pathways are also warranted to circumvent the increasing trend toward amputation, because salvage surgical intervention reduces the risk of treatment failure, mortality, and amputation.
Details
- Title: Subtitle
- The clinical epidemiology of chronic osteomyelitis: trends, treatment utilization, and outcomes
- Creators
- Rawabi Aljadani
- Contributors
- Martha Carvour (Advisor)Margaret Chorazy (Advisor)Ryan Carnahan (Committee Member)Hyunkeun Cho (Committee Member)James Torner (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Epidemiology
- Date degree season
- Summer 2024
- DOI
- 10.25820/etd.007610
- Publisher
- University of Iowa
- Number of pages
- xi, 133 pages
- Copyright
- Copyright 2024 Rawabi Aljadani
- Language
- English
- Date submitted
- 07/17/2024
- Description illustrations
- illustrations, tables, graphs
- Description bibliographic
- Includes bibliographical references (pages 107-116).
- Public Abstract (ETD)
- A bone infection can have a life-changing effect. A patient's life and independence might be at risk since bone infection can result in amputation or disability. Yet, research about bone infections is limited. In this dissertation, we investigated bone infections. We started by evaluating trends in the occurrence of bone infections. Next, we assessed the use of different surgeries to treat bone infections. Lastly, we compared treatment outcomes between patients who underwent surgery and those who did not. We observed a stable trend in the incidence of chronic bone infections, with a slight decrease that began during the COVID-19 pandemic. Additionally, we noticed an increasing occurrence of spinal (vertebral) bone infections and a growing trend in surgeries to removed infected limbs. Furthermore, we found that undergoing surgery for bone infection reduced the risk of treatment failure, limb loss, and death. The occurrence of bone infections is changing over time. The use of surgical treatments for bone infections is also changing over time. The occurrence of some bone infections, such as spinal (vertebral) bone infections, is increasing; but surgery for bone infections may help to improve outcomes for patients affected by these infections. More research is needed to understand the best ways to treat bone infections and to ensure that patients with bone infections have access to necessary surgical treatments.
- Academic Unit
- Epidemiology
- Record Identifier
- 9984698352402771
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