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Recent Increase in the Rate of Spinal Infections May be Related to Growing Substance-use Disorder in the State of Washington

Wide Population-based Analysis of the Comprehensive Hospital Abstract Reporting System (CHARS) Database

Blecher, Ronen, MD, PhD∗,§,¶; Yilmaz, Emre, MD; Ishak, Basem, MD; Drazin, Doniel, MD, PhD; Oskouian, Rod J., MD; Chapman, Jens R., MD

doi: 10.1097/BRS.0000000000002819

Study Design. Epidemiological study.

Objective. The aim of this study was to evaluate trends in the incidence of spinal infections (SI) and the possible role of substance use disorder (SUD) as a key associated factor.

Summary of Background Data. SI pose major diagnostic and therapeutic challenge in developed countries, resulting in substantial morbidity and mortality. With an estimated incidence of up to 1:20,000, recent clinical experiences suggest that this rate may be rising.

Methods. To evaluate a possible change in trend in the proportion of SI, we searched the Washington state Comprehensive Hospital Abstract Reporting System (CHARS) data during a period of 15 years. We retrieved ICD-9 and 10 codes, searching for all conditions that are regarded as SI (discitis, osteomyelitis, and intraspinal abscess), as well as major known SI-related risk factors.

Results. We found that the proportion of SI among discharged patients had increased by around 40% during the past 6 years, starting at 2012 and increasing steadily thereafter. Analysis of SI-related risk factors within the group of SI revealed that proportion of SUD and malnutrition had undergone the most substantial change, with the former increasing >3-fold during the same period.

Conclusion. Growing rates of drug abuse, drug dependence, and malnutrition throughout the State of Washington may trigger a substantial increase in the incidence of spinal infections in discharged patients. These findings may provide important insights in planning prevention strategies on a broader level.

Level of Evidence: 4

The rate of spinal infections (SI) in developed countries may be increasing. Analysis of the Washington state CHARS database shows that the proportion of SI within discharged patients has increased by 40% in recent years and that the two main associated risk factors are substance use disorder and malnutrition.

Swedish Neuroscience Institute, Seattle, WA

Seattle Science Foundation, Seattle, WA

Evergreen Hospital Neuroscience Institute, WA

§Orthopedic Department, Assaf Harofeh Medical Center, Affiliated to the Tel-Aviv University, Zeriffin, Israel

Sackler School of Medicine, Affiliated with the Tel Aviv University, Israel.

Address correspondence and reprint requests to Jens R. Chapman, MD, Ronen Blecher MD, PhD, Swedish Neuroscience Institute, Seattle, WA 98122; E-mail:,

Received 1 May, 2018

Revised 3 July, 2018

Accepted 12 July, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: employment.

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