Incidence and Risk Factors for Symptomatic Spinal Epidural Hematoma Following Posterior Thoracic Spinal Surgery in a Single Institute

Wang, Longjie; Wang, Hui; Sun, Zhuoran; Chen, Zhongqiang; Sun, Chuiguo; Li, Weishi

doi:10.1177/2192568220979141

Cited by 12 publications

(35 citation statements)

References 25 publications

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“…In our cohort of patients, we found out that obesity (abnormal level of BMI above 30 kg/m 2 ) is a signifi cant risk factor for the incidence of postoperative symptomatic SEDH. Our fi ndings confi rm previous studies -the incidence of symptomatic SEDH requiring evacuation ranges from 0.1 % to 3.7 % (3,(9)(10)(11).…”

Section: Discussionsupporting

confidence: 91%

“…In the postoperative period, there is an increased risk of impaired wound healing due to low regional perfusion and oxygen tension, infectious complications and last but not least, worsened and limited rehabilitation after surgical procedure (7,8,11,12). From the perspective of spine surgery, if a patient after surgery does not follow an adequate regular rehabilitation and suffi cient physical activity, obesity of the patient leads to a higher risk for recurrence of degenerative spine diffi culties requiring revision surgery.…”

Section: Discussionmentioning

confidence: 99%

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Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

Snopko¹,

Opšenák²,

Hanko³

et al. 2021

BLL

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INTRODUCTION: The occurrence of symptomatic spinal epidural hematoma after spine surgery is a rare, but serious major complication whose incidence usually requires urgent surgical intervention. Obesity is currently considered to be one of the most common metabolic diseases. METHODS: Prospective analysis of patients who underwent surgical treatment of degenerative lumbar spine disease from January 2016 to February 2018 with one-year follow-up. All patients underwent decompression of spinal cord and nerve roots. This study was conducted to determine an association between the incidence of spinal epidural hematoma (SEDH) requiring surgical treatment and obesity/body mass index (BMI). RESULTS: In our study, data from 371 patients were assessed. SEDH requiring surgical intervention occurred totally in seven patients (1.89 %). An average BMI in patients with presence of SEDH was 30.67 kg/m 2 . Our work showed a statistically signifi cant difference between BMI in patients with SEDH compared to patients without SEDH (p = 0.0044). This study also showed a signifi cant difference in incidence of symptomatic SEDH in obese patients compared to non-obese patients (p = 0.0158). CONCLUSION: In our study, we found out that obesity is a signifi cant risk factor for the incidence of postoperative SEDH after degenerative lumbar spine surgery (Tab. 1, Fig. 2, Ref. 18).

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

Snopko¹,

Opšenák²,

Hanko³

et al. 2021

BLL

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“…Risk factors guide surgeons in selecting appropriate procedures and gauging possible complications. Some reported risk factors included obesity, diabetes, advanced age, tumor history, and preoperative steroid use and son on 5,8,19,26. In our study, multivariate analysis indicated that risks of reoperation increased by 2.2 times, 1.9 times, and 1.7 times in patients who underwent upper thoracic spine surgery, got a thoracic kyphosis ≥45°, and suffered from an intraoperative dural tear, respectively.…”

Section: Discussionmentioning

confidence: 49%

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients

Ouyang

Yang

et al. 2022

Spine

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Study Design. A retrospective study. Objective. The purpose of this study is to identify the incidences, causes, and risk factors of 30-day unplanned reoperation of posterior surgery for thoracic spinal stenosis (TSS) based on 1948 patients in a single center. Summary of Background Data. Unplanned reoperation is suggested to be a useful quality indicator for spine surgery. However, the incidences, causes, and risk factors of 30-day unplanned reoperation in patients who underwent posterior spinal surgery for TSS have not been well-established. Materials and Methods. We retrospectively analyzed the clinical data of patients who underwent posterior spinal surgery for TSS from January 2011 to December 2021. Statistical methods including univariate and multivariate analyses were performed to assess the incidences, causes, and risk factors. Results. A total of 1948 patients who underwent posterior spinal surgery for TSS in our institution were reviewed, and 77 (3.95%) required unplanned reoperations within 30 days because of epidural hematoma (1.64%), wound-related complications (1.02%), inadequate decompression (0.41%), and implant malposition or failure (0.36%), neurological deficit (0.26%), and other causes (0.26%). After univariate analysis, seven clinical factors were associated with unplanned reoperation (P<0.05). Multivariate logistic regression analysis showed that upper thoracic spine surgery (P=0.010), thoracic kyphosis ≥45° (P=0.039), and intraoperative dural injury (P=0.047) were independent risk factors for 30-day unplanned reoperation of posterior surgery for TSS. Conclusions. The incidence of 30-day unplanned reoperations after posterior surgical treatment for TSS was 3.95%. The most common causes were epidural hematoma, wound-related complications, inadequate decompression, and implant malposition or failure. Upper thoracic spine surgery, thoracic kyphosis ≥45°, and intraoperative dural injury led to an increased risk of unplanned reoperation within 30 days after posterior spinal surgery for TSS. Level of Evidence. 4.

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“…The surgical sites were divided into cervical [8,10,11,13,14,19,28,36,37,[40][41][42][43][44][45], thoracic [8,11,13,19,28,31,[40][41][42][44][45][46] and lumbar [5, 8, 9, 11, 13, 16-22, 28, 29, 32-35, 40-42, 44-46] surgery with 15, 12 and 25 studies including 27,779, 16,897, 80,766 patients, respectively, and 72, 104 and 356 patients developed SSEH, respectively. The pooled incidence of SSEH was 0.32% (95% CI 0.002-0.005, P < 0.01, I 2 = 63%) for cervical surgery, 0.84% (95% CI 0.004-0.017, P < 0.01, I 2 = 88%) for thoracic surgery, and 0.63% (95% CI 0.004-0.010, P < 0.01, I 2 = 92%) for lumbar surgery.…”

Section: Surgical Sitementioning

confidence: 99%

Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis

et al. 2022

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Purpose This systematic review and meta-analysis aimed to determine the incidence of symptomatic spinal epidural hematoma (SSEH) following spine surgery. Methods We systematically searched for all relevant articles that mentioned the incidence of SSEH following the spine surgery published in the PubMed, Embase, and Cochrane Library databases through March 2022 and manually searched the reference lists of included studies. The Newcastle–Ottawa quality assessment scale (NOS) was used to assess the quality of the included studies. A fixed-effects or random-effects model was performed to calculate the pooled incidence of the totality and subgroups based on the heterogeneity. The potential publication bias was assessed by Egger's linear regression and a funnel plot. Sensitivity analysis was also conducted. Results A total of 40 studies were included in our meta-analysis based on our inclusion and exclusion criteria. The overall pooled incidence of SSEH was 0.52% (95% CI 0.004–0.007). In the subgroup analysis, the pooled incidence of SSEH in males and females was 0.86% (95% CI 0.004–0.023) and 0.68% (95% CI 0.003–0.017). Among the different indications, a higher incidence (2.9%, 95% CI 0.006–0.084) was found in patients with deformity than degeneration (1.12%, 95% CI 0.006–0.020) and tumor (0.30%, 95% CI 0.006–0.084). For different surgical sites, the incidences of SSEH in cervical, thoracic and lumbar spine were 0.32% (95% CI 0.002–0.005), 0.84% (95% CI 0.004–0.017) and 0.63% (95% CI 0.004–0.010), respectively. The incidences of SSEH in anterior and posterior approach were 0.24% (95% CI 0.001–0.006) and 0.70% (95% CI 0.004–0.011), respectively. The pooled incidence of SSEH was five times higher with minimally invasive surgery (1.94%, 95% CI 0.009–0.043) than with open surgery (0.42%, 95% CI 0.003–0.006). Delayed onset of SSEH had a lower incidence of 0.16% (95% CI 0.001–0.002) than early onset. There were no significant variations in the incidence of SSEH between patients who received perioperative anticoagulation therapy and those who did not or did not report getting chemopreventive therapy (0.44%, 95% CI 0.006–0.084 versus 0.42%, 95% CI 0.003–0.006). Conclusion We evaluated the overall incidence proportion of SSEH after spine surgery and performed stratified analysis, including sex, surgical indication, site, approach, minimally invasive surgery, and delayed onset of SSEH. Our research would be helpful for patients to be accurately informed of their risk and for spinal surgeons to estimate the probability of SSEH after spine surgery.

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Incidence and Risk Factors for Symptomatic Spinal Epidural Hematoma Following Posterior Thoracic Spinal Surgery in a Single Institute

Cited by 12 publications

References 25 publications

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

Thirty-day Unplanned Reoperations After Posterior Surgery for Thoracic Spinal Stenosis: A Single-center Study Based on 1948 Patients

Incidence of postoperative symptomatic spinal epidural hematoma requiring surgical evacuation: a systematic review and meta-analysis

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