Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

Abstract

BackgroundPostoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability.MethodsThis was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15.ResultsThe remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application.ConclusionsWith a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

Deep Cervical Artery as a Source of Bleeding in Postoperative Spinal Epidural Hematoma: A Case Report

“…It has also been reported that connecting the drain to a suction system as quickly as possible during the operation reduces the occurrence rate of pSEH because coagulation of extravascular blood inadvertently causes pSEH. 17) In our case, the drain was connected to the suction system before wound closure, and there were no problems in the drain's function.…”

Compression Therapy Following Posterior Lumbar Interbody Fusion: A Prospective, Randomized, Clinical Study

“…However, the range of incidence of wound-related complications after spinal surgery was 0.4-20% [23][24][25] , which are an inevitable problem faced by spinal surgeons. Thus, the usage of negative pressure drainage in posterior spinal surgery is controversial [12][13][14].…”

“…Negative pressure drainage has shown to accelerate wound healing by advancing angiogenesis, improving microvascular blood flow, triggering granulation tissue formation, and decreasing edema [11] . Contrarily, a few studies have shown that negative pressure drainage is not beneficial in spinal surgery [12,13] . Closed suction drainage is another method that could intensify postoperative blood loss and require transfusion [14] .…”

Compression Therapy Following Posterior Lumbar Interbody Fusion: A Prospective, Randomized, Clinical Study

“…However, the range of incidence of wound-related complications after spinal surgery was 0.4-20% [23][24][25] , which are an inevitable problem faced by spinal surgeons. Thus, the usage of negative pressure drainage in posterior spinal surgery is controversial [12][13][14].…”