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

Snopko, Pavol; Opšenák, René; Hanko, Martin; Benčo, Martin; Kolarovszki, Branislav

doi:10.4149/bll_2021_095

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…A total of ten studies 16 , 22 , 31 , 33 , 38 – 40 , 42 , 43 reported an association between older age (≥60 years) and postoperative SEH. In four studies 33 , 39 , 40 , 43 , symptomatic SEH occurred 1–15 days after surgery; in three studies 16 , 22 , 31 , SEH occurred between 1 and 6 months after surgery; and the remaining three studies 38 , 42 , 52 did not specify when SEH occurred. Multivariate logistic regression analysis was performed in all 8 studies 16 , 22 , 33 , 38 – 40 , 43 , 52 .…”

Section: Resultsmentioning

confidence: 99%

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Risk factors of epidural hematoma in patients undergoing spinal surgery: a meta-analysis of 29 cohort studies

Luo,

Cao,

Zhao

et al. 2023

International Journal of Surgery

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Objective: The authors conducted this meta-analysis to identify risk factors for spinal epidural haematoma (SEH) among patients following spinal surgery. Methods: The authors systematically searched Pub: Med, Embase, and the Cochrane Library for articles that reported risk factors associated with the development of SEH in patients undergoing spinal surgery from inception to 2 July 2022. The pooled odds ratio (OR) was estimated using a random-effects model for each investigated factor. The evidence of observational studies was classified as high quality (Class I), moderate quality (Class II or III) and low quality (Class IV) based on sample size, Egger’s P value and between-study heterogeneity. In addition, subgroup analyses stratified by study baseline characteristics and leave-one-out sensitivity analyses were performed to explore the potential sources of heterogeneity and the stability of the results. Results: Of 21 791 articles screened, 29 unique cohort studies comprising 150 252 patients were included in the data synthesis. Studies with high-quality evidence showed that older patients (≥60 years) (OR, 1.35; 95% CI, 1.03–1.77) were at higher risk for SEH. Studies with moderate-quality evidence suggested that patients with a BMI greater than or equal to 25 kg/m² (OR, 1.39; 95% CI, 1.10–1.76), hypertension (OR, 1.67; 95% CI, 1.28–2.17), and diabetes (OR, 1.25; 95% CI, 1.01–1.55) and those undergoing revision surgery (OR, 1.92; 95% CI, 1.15–3.25) and multilevel procedures (OR, 5.20; 95% CI, 2.89–9.37) were at higher risk for SEH. Meta-analysis revealed no association between tobacco use, operative time, anticoagulant use or American Society of Anesthesiologists (ASA) classification and SEH. Conclusions: Obvious risk factors for SEH include four patient-related risk factors, including older age, obesity, hypertension and diabetes, and two surgery-related risk factors, including revision surgery and multilevel procedures. These findings, however, must be interpreted with caution because most of these risk factors had small effect sizes. Nonetheless, they may help clinicians identify high-risk patients to improve prognosis.

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Section: Resultsmentioning

confidence: 99%

“…Obesity is an important risk factor for postoperative symptomatic SEH. Obese patients usually require a special posture or a more extensive surgical approach, leading to more soft tissue injury, increased blood loss and a prolonged operation time 42 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors of epidural hematoma in patients undergoing spinal surgery: a meta-analysis of 29 cohort studies

Luo,

Cao,

Zhao

et al. 2023

International Journal of Surgery

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“…Of note, the overwhelming majority of these epidural hematomas are asymptomatic, with only 1.2–5.1% of patients undergoing revision surgery for hematoma evacuation. Previous studies, such as that by Snopko et al, have shown in traditional open approaches, obesity can be an independent risk factor for symptomatic epidural hematoma [ 41 ]. However, our results did not yield any increased risk of this complication due to obesity, which may be due to endoscopic techniques requiring excellent hemostasis for intra-operative visualization, in addition to less bony resection and creation of dead space as compared to open surgery, thereby providing a protective effect in an at-risk population [ 2 , 5 , 26 , 34 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Does obesity and varying body mass index affect the clinical outcomes and safety of biportal endoscopic lumbar decompression? A comparative cohort study

Olson,

Upfill-Brown,

Adejuyigbe

et al. 2024

Acta Neurochir

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Background Endoscopic spine surgery has recently grown in popularity due to the potential benefits of reduced pain and faster recovery time as compared to open surgery. Biportal spinal endoscopy has been successfully applied to lumbar disc herniations and lumbar spinal stenosis. Obesity is associated with increased risk of complications in spine surgery. Few prior studies have investigated the impact of obesity and associated medical comorbidities with biportal spinal endoscopy. Methods This study was a prospectively collected, retrospectively analyzed comparative cohort design. Patients were divided into cohorts of normal body weight (Bone Mass Index (BMI)18.0–24.9), overweight (BMI 25.0–29.9) and obese (BMI > 30.0) as defined by the World Health Organization (WHO). Patients underwent biportal spinal endoscopy by a single surgeon at a single institution for treatment of lumbar disc herniations and lumbar spinal stenosis. Demographic data, surgical complications, and patient-reported outcomes were analyzed. Statistics were calculated amongst treatment groups using analysis of variance and chi square where appropriate. Statistical significance was determined as p < 0.05. Results Eighty-four patients were followed. 26 (30.1%) were normal BMI, 35 (41.7%) were overweight and 23 (27.4%) were obese. Patients with increasing BMI had correspondingly greater American Society of Anesthesiologist (ASA) scores. There were no significant differences in VAS Back, VAS Leg, and ODI scores, or postoperative complications among the cohorts. There were no cases of surgical site infections in the cohort. All cohorts demonstrated significant improvement up to 1 year postoperatively. Conclusions This study demonstrates that obesity is not a risk factor for increased perioperative complications with biportal spinal endoscopy and has similar clinical outcomes and safety profile as compared to patients with normal BMI. Biportal spinal endoscopy is a promising alternative to traditional techniques to treat common lumbar pathology.

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“…26 Surgical site hematoma is a known complication, especially in patients who are already on antiplatelet or anticoagulation therapy. 27 In addition, it has been reported that transfusion 28 and obesity 29 were risk factors for spinal epidural hematoma. In the present study, patients with postoperative hematoma did not receive anticoagulation therapy or transfusion, and body mass index (BMI) was within the normal range.…”

Section: Discussionmentioning

confidence: 99%

Trend of unplanned reoperation rates after lumbar degenerative surgery from 2011 to 2019: a large patient population study

Luo

Sun

et al. 2023

ANZ Journal of Surgery

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Background: Unplanned reoperation is commonly performed due to postoperative complications. Previous studies have reported the incidence of unplanned reoperation following lumbar spinal surgery. But few study focused on the trend of reoperation rates, and the reasons of unplanned reoperation were not clear. In this study, we conducted a retrospective study to determine the trend of unplanned reoperation rates after degenerative lumbar spinal surgery from 2011 to 2019, and the reasons and risk factors of unplanned reoperation were also determined. Methods: Data of patients who were diagnosed with degenerative lumbar spinal disease and underwent posterior lumbar spinal fusion surgery in our institution from January 2011 to December 2019 were reviewed. Those who received unplanned reoperation during the primary admission were identified. The demographics, diagnosis, surgical segments and postoperative complications of these patients were recorded. The rates of unplanned reoperation from 2011 to 2019 were calculated, and the reasons of unplanned reoperation were statistically analysed. Results: A total of 5289 patients were reviewed. Of them, 1.91% (n = 101) received unplanned reoperation during the primary admission. The unplanned reoperation rates of degenerative lumbar spinal surgery firstly increased from 2011 to 2014, with a peak rate in 2014 (2.53%). Then, the rates decreased from 2014 to 2019, with the lowest one in 2019 (1.46%). Patients with lumbar spinal stenosis have a higher rate of unplanned reoperation (2.67%) compared with those diagnosed as lumbar disc herniation (1.50%) and lumbar spondylolisthesis (2.04%) (P < 0.05). The main reasons for unplanned reoperation were wound infection (42.57%), followed by wound hematoma (23.76%). Patients who underwent 2-segment spinal surgery had a higher unplanned reoperation rate (3.79%) than those receiving other segments surgery (P < 0.001). And different spine surgeons had different reoperation rates. Conclusions: The rates of unplanned reoperation after lumbar degenerative surgery increased at first and then decreased during past 9 years. Wound infection was the major reason for unplanned reoperation. 2-segment surgery and surgeon's surgical skills were related to the reoperation rate.

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

Cited by 7 publications

References 12 publications

Risk factors of epidural hematoma in patients undergoing spinal surgery: a meta-analysis of 29 cohort studies

Risk factors of epidural hematoma in patients undergoing spinal surgery: a meta-analysis of 29 cohort studies

Does obesity and varying body mass index affect the clinical outcomes and safety of biportal endoscopic lumbar decompression? A comparative cohort study

Trend of unplanned reoperation rates after lumbar degenerative surgery from 2011 to 2019: a large patient population study

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