학술논문
Symptomatic Epidural Hematoma after Elective Posterior Lumbar Decompression: Incidence, Timing, Risk Factors, and Associated Complications.
Document Type
Academic Journal
Author
Knusel K; Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106 USA.; Du JY; University Hospitals/Cleveland Medical Center Department of Orthopedics, 11100 Euclid Avenue, Cleveland, OH 44106 USA.; MetroHealth Medical Center, 2500 MetroHealth Dr., Cleveland, OH 44109 USA.; Ren B; Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106 USA.; Kim CY; University Hospitals/Cleveland Medical Center Department of Orthopedics, 11100 Euclid Avenue, Cleveland, OH 44106 USA.; Ahn UM; New Hampshire NeuroSpine Institute, 4 Hawthorne Dr, Bedford, NH 03110 USA.; Ahn NU; University Hospitals/Cleveland Medical Center Department of Orthopedics, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
Source
Publisher: SAGE Country of Publication: United States NLM ID: 101273938 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1556-3316 (Print) Linking ISSN: 15563316 NLM ISO Abbreviation: HSS J Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
1556-3316
Abstract
Background: Symptomatic post-operative lumbar epidural hematoma (PLEH) is a complication of lumbar spine surgery that can cause permanent neurologic consequences through compression of the cauda equina and nerve roots.
Questions/purposes: We sought to investigate the incidence, timing, and risk factors for symptomatic epidural hematomas following posterior lumbar decompression, as well as to identify additional post-operative complications associated with symptomatic lumbar epidural hematomas.
Methods: Elective lumbar spine procedures were identified in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016. Analyzed predictors of reoperation or readmission within 30 days for symptomatic PLEH included demographics, comorbidities, pre-operative laboratory values, peri-operative characteristics, and post-operative complications.
Results: There were 75,878 cases included in the analysis. The incidence rate of symptomatic PLEH was 0.27% ( n = 206), 54.4% ( n = 112) of which occurred within 5 days of the procedure. Increased age, obesity (body mass index of 35 or higher), peri-operative transfusion, multilevel surgery (two or more levels), dural tear repair, and microscope use were independently associated with PLEH. Post-operative complications associated with PLEH included surgical site infection and urinary tract infection.
Conclusions: Readmission or reoperation for symptomatic PLEH following elective lumbar spine surgery is rare and can occur many days or weeks after a procedure. There are modifiable risk factors for PLEH and associated additional post-operative complications that physicians should be suspicious of following posterior lumbar decompression.
Competing Interests: Conflict of InterestKonrad Knusel MS, Jerry Y. Du MD, Bryan Ren BS, Chang-Yeon Kim MD, MS, Uri M. Ahn MD, Nicholas U. Ahn MD, declare that they have no conflicts of interest.
(© Hospital for Special Surgery 2019.)
Questions/purposes: We sought to investigate the incidence, timing, and risk factors for symptomatic epidural hematomas following posterior lumbar decompression, as well as to identify additional post-operative complications associated with symptomatic lumbar epidural hematomas.
Methods: Elective lumbar spine procedures were identified in the National Surgical Quality Improvement Program (NSQIP) database between 2012 and 2016. Analyzed predictors of reoperation or readmission within 30 days for symptomatic PLEH included demographics, comorbidities, pre-operative laboratory values, peri-operative characteristics, and post-operative complications.
Results: There were 75,878 cases included in the analysis. The incidence rate of symptomatic PLEH was 0.27% ( n = 206), 54.4% ( n = 112) of which occurred within 5 days of the procedure. Increased age, obesity (body mass index of 35 or higher), peri-operative transfusion, multilevel surgery (two or more levels), dural tear repair, and microscope use were independently associated with PLEH. Post-operative complications associated with PLEH included surgical site infection and urinary tract infection.
Conclusions: Readmission or reoperation for symptomatic PLEH following elective lumbar spine surgery is rare and can occur many days or weeks after a procedure. There are modifiable risk factors for PLEH and associated additional post-operative complications that physicians should be suspicious of following posterior lumbar decompression.
Competing Interests: Conflict of InterestKonrad Knusel MS, Jerry Y. Du MD, Bryan Ren BS, Chang-Yeon Kim MD, MS, Uri M. Ahn MD, Nicholas U. Ahn MD, declare that they have no conflicts of interest.
(© Hospital for Special Surgery 2019.)