The Clinical Epidemiology of Chronic Osteomyelitis: Trends, Treatment Utilization, and Outcomes

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.