Incidence and clinical associations of in-hospital bacterial meningitis after cervical spine fusion: a nationwide inpatient sample analysis.
6 affiliations
- 1Department of Orthopedic Surgery, Brookdale University Hospital, Brooklyn, USA.
- 2Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, USA.
- 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA.
- 4The University of Texas Health Science Center at Houston, Houston, USA.
- 5Rutgers Robert Wood Johnson Medical School, New Brunswick, USA.
- 6Department of Orthopaedic Surgery, NewYork-Presbyterian/Lower Manhattan Hospital, New York, USA.
Abstract
In-hospital bacterial meningitis following cervical spine fusion is an uncommon but potentially devastating complication. Due to its rarity, limited data exist regarding its incidence, associated clinical factors, and impact on hospitalization outcomes. This study aimed to characterize the incidence, clinical associations, and outcomes of bacterial meningitis occurring during the index hospitalization following elective cervical spine fusion using a large national database. A retrospective cross-sectional analysis of patients aged ≥18 years who underwent elective cervical spinal fusion between 2002 and 2014 was performed using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Cervical fusion procedures were identified using International Classification of Diseases (ICD)-9-CM procedure codes for anterior (81.02) and posterior (81.03) cervical fusion. In-hospital postoperative bacterial meningitis was identified using ICD-9 diagnosis codes (320.0-320.9) recorded during the index admission. Postoperative cerebrospinal fluid (CSF) leak was identified using ICD-9 diagnosis codes for dural tear and CSF-related complications. Patient characteristics, CSF leak status, surgical approach, length of stay (LOS), hospital charges, and mortality were analyzed. Given the extremely low event rate, regression analyses were considered exploratory and interpreted cautiously. A total of 325,241 elective cervical fusion admissions were identified, including 296,894 (91.3%) anterior and 28,347 (8.7%) posterior cervical fusion procedures. In-hospital bacterial meningitis occurred in 12 patients (0.004%). Patients with a documented postoperative CSF leak had a higher observed incidence of meningitis compared with those without a CSF leak [0.4% (6/1,390) vs. 0.002% (6/323,851)]. Among patients with CSF leaks, posterior cervical fusion was associated with a higher likelihood of meningitis compared with anterior fusion in exploratory regression analysis [odds ratio (OR) 8.4; 95% confidence interval (CI): 1.44-48.6; P=0.02]. Patients with meningitis experienced longer hospitalizations (19.0±9.9 vs. 1.91±2.4 days; P<0.001), higher hospital charges ($202,739.6±177,448.7 vs. $48,176.8±41,244.4; P<0.001), and higher mortality [2/12 (16.7%) vs. 0.1%]. Bacterial meningitis following cervical spine fusion during the index hospitalization is exceedingly rare but associated with substantial morbidity. A postoperative CSF leak was strongly associated with meningitis occurrence, particularly among patients undergoing posterior cervical fusion. These findings support heightened clinical awareness and early diagnostic evaluation in patients who develop CSF leakage after cervical fusion. Further studies are needed to validate these associations and determine preventive strategies.
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BibTeX
@article{hanna2026incidence,
title = {{Incidence and clinical associations of in-hospital bacterial meningitis after cervical spine fusion: a nationwide inpatient sample analysis.}},
author = {Gabriel Hanna and Alejandro Pando and Michael M Abdou and Rita Chamoun and Caryn J Ha and Robert Kamil and Braden Goldberg and Eli Bryk},
journal = {Journal of spine surgery (Hong Kong)},
year = {2026},
month = sep,
doi = {10.21037/jss-2026-1-0011},
url = {https://europepmc.org/article/MED/42996286},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Incidence and clinical associations of in-hospital bacterial meningitis after cervical spine fusion: a nationwide inpatient sample analysis.
AU - Gabriel Hanna
AU - Alejandro Pando
AU - Michael M Abdou
AU - Rita Chamoun
AU - Caryn J Ha
AU - Robert Kamil
AU - Braden Goldberg
AU - Eli Bryk
PY - 2026
DA - 2026/09/28
JO - Journal of spine surgery (Hong Kong)
DO - 10.21037/jss-2026-1-0011
UR - https://europepmc.org/article/MED/42996286
AB - In-hospital bacterial meningitis following cervical spine fusion is an uncommon but potentially devastating complication. Due to its rarity, limited data exist regarding its incidence, associated clinical factors, and impact on hospitalization outcomes. This study aimed to characterize the incidence, clinical associations, and outcomes of bacterial meningitis occurring during the index hospitalization following elective cervical spine fusion using a large national database. A retrospective cross-sectional analysis of patients aged ≥18 years who underwent elective cervical spinal fusion between 2002 and 2014 was performed using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Cervical fusion procedures were identified using International Classification of Diseases (ICD)-9-CM procedure codes for anterior (81.02) and posterior (81.03) cervical fusion. In-hospital postoperative bacterial meningitis was identified using ICD-9 diagnosis codes (320.0-320.9) recorded during the index admission. Postoperative cerebrospinal fluid (CSF) leak was identified using ICD-9 diagnosis codes for dural tear and CSF-related complications. Patient characteristics, CSF leak status, surgical approach, length of stay (LOS), hospital charges, and mortality were analyzed. Given the extremely low event rate, regression analyses were considered exploratory and interpreted cautiously. A total of 325,241 elective cervical fusion admissions were identified, including 296,894 (91.3%) anterior and 28,347 (8.7%) posterior cervical fusion procedures. In-hospital bacterial meningitis occurred in 12 patients (0.004%). Patients with a documented postoperative CSF leak had a higher observed incidence of meningitis compared with those without a CSF leak [0.4% (6/1,390) vs. 0.002% (6/323,851)]. Among patients with CSF leaks, posterior cervical fusion was associated with a higher likelihood of meningitis compared with anterior fusion in exploratory regression analysis [odds ratio (OR) 8.4; 95% confidence interval (CI): 1.44-48.6; P=0.02]. Patients with meningitis experienced longer hospitalizations (19.0±9.9 vs. 1.91±2.4 days; P<0.001), higher hospital charges ($202,739.6±177,448.7 vs. $48,176.8±41,244.4; P<0.001), and higher mortality [2/12 (16.7%) vs. 0.1%]. Bacterial meningitis following cervical spine fusion during the index hospitalization is exceedingly rare but associated with substantial morbidity. A postoperative CSF leak was strongly associated with meningitis occurrence, particularly among patients undergoing posterior cervical fusion. These findings support heightened clinical awareness and early diagnostic evaluation in patients who develop CSF leakage after cervical fusion. Further studies are needed to validate these associations and determine preventive strategies.
SN - 2414-469X
SN - 2414-4630
ER -