Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2020 | Anticoagulant | Research article

Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database

Authors: Ji Hyun Park, Sunny Park, Soo An Choi

Published in: BMC Musculoskeletal Disorders | Issue 1/2020

Abstract

Background

With increasing number of patients undergoing spine surgery, the spinal epidural hemorrhage (SEH) has become a growing concern. However, current studies on SEH rely on case reports or observations from a single center. Our study attempted to demonstrate the incidence rate and risk factors of SEH using a national dataset.

Methods

A total of 17,549 spine surgery cases from the Health Insurance Review and Assessment Service National Inpatient Sample of 2014 were analyzed. After evaluating the incidence of SEH based on severe cases requiring reoperation, a univariate comparison was performed. Variables found to be significant were included in a multivariable analysis model to determine the risk factors.

Results

The incidence of SEH was found to be 1.15% in Korean population, and there were no severe SEH cases. Our analysis confirmed the previous findings that lumbar surgery, intraoperative blood loss, prolonged surgical time, high blood pressure, use of nonsteroidal anti-inflammatory drugs, and concurrent bleeding factors are the risk factors of SEH. Anterior approach showed a protective effect. The use of anticoagulant demonstrated no statistical significance.

Conclusion

Although severe SEH cases were not detected, the incidence of SEH was similar to that reported in literature. Given that SEH is a rare complication of spine surgery and constitutes an important research area that needs to be studied further, our study makes a meaningful contribution based on a rigorous national level sample for the first time and provides the academic circle and health professionals with a reliable evidence of improved clinical outcomes in such cases.

Available only for authorised users

Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S. Epidemiological trends in spine surgery over 10 years in a multicenter database. Euro Spine J. 2018;27(8):1698–703. https://doi.org/10.1007/s00586-018-5513-4.CrossRef

Szpalski M, Gunzburg R, Melot C, Aebi M. The aging of the population: a growing concern for spine care in the twenty-first century. Euro Spine J. 2003;12(Suppl 2):S81–3. https://doi.org/10.1007/s00586-003-0592-1.CrossRef

Lillemae K, Jarvio J, Silvasti-Lundell MK, Antinheimo J, Hernesniemi J, Niemi TT. Incidence of postoperative hematomas requiring surgical treatment in neurosurgery: a retrospective observational study. World Neurosurg. 2017;108:491–7. https://doi.org/10.1016/j.wneu.2017.09.007.CrossRefPubMed

Schroeder GD, Kurd MF, Kepler CK, Arnold PM, Vaccaro AR. Postoperative epidural hematomas in the lumbar spine. J Spinal Disord Tech. 2015;28(9):313–8. https://doi.org/10.1097/BSD.0000000000000329.CrossRefPubMed

Ross JS, Masaryk TJ, Modic MT, Bohlman H, Delamater R, Wilber G. Lumbar spine: postoperative assessment with surface-coil MR imaging. Radiology. 1987;164(3):851–60. https://doi.org/10.1148/radiology.164.3.3615887.CrossRefPubMed

Dina T, Boden S, Davis D. Lumbar spine after surgery for herniated disk: imaging findings in the early postoperative period. AJR Am J Roentgenol. 1995;164(3):665–71.CrossRef

Luo XB, Zhou X, Wang Q, Cai XJ, Luo ZP, Ma YZ. The classification of recurrent spinal epidural hematoma: a review of the literature and a comparison with the cases. Euro Spine J. 2016;25(Suppl 1):224–9. https://doi.org/10.1007/s00586-016-4506-4.CrossRef

Kim JE, Choi DJ, Park E. Evaluation of postoperative spinal epidural hematoma after Biportal endoscopic spine surgery for single-level lumbar spinal stenosis: clinical and magnetic resonance imaging study. World Neurosurg. 2019. https://doi.org/10.1016/j.wneu.2019.02.150.CrossRef

Korean Information Center for Disease. Disease codes status of admission and outpatient treatment Aug 16, 2018. http://www.koicd.kr/2016/stats/diseaseStats.do. Accessed 16 Aug 2018.

10.

Oecd. Strengthening Health Information Infrastructure for Health Care Quality Governance. 2013.CrossRef

11.

Bovonratwet P, Fu MC, Tyagi V, et al. Incidence, risk factors, and clinical implications of postoperative hematoma requiring reoperation following anterior cervical discectomy and fusion. Spine. 2019;44(8):543–9. https://doi.org/10.1097/BRS.0000000000002885.CrossRefPubMed

12.

Kou J, Fischgrund J, Biddinger A, Herkowitz H. Risk factors for spinal epidural hematoma after spinal surgery. Spine. 2002;27(15):1670–3.CrossRef

13.

Rogers SO, Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am College Surgeons. 2007;204(6):1211–21. https://doi.org/10.1016/j.jamcollsurg.2007.02.072.CrossRef

14.

Kanchanabat B, Stapanavatr W, Meknavin S, Soorapanth C, Sumanasrethakul C, Kanchanasuttirak P. Systematic review and meta-analysis on the rate of postoperative venous thromboembolism in orthopaedic surgery in Asian patients without thromboprophylaxis. Br J Surg. 2011;98(10):1356–64. https://doi.org/10.1002/bjs.7589.CrossRefPubMed

15.

Bono CM, Watters WC, Heggeness MH, et al. An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery. Spine J. 2009;9(12):1046–51. https://doi.org/10.1016/j.spinee.2009.09.005.CrossRefPubMed

16.

Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2, Supplement):e278S–325S. https://doi.org/10.1378/chest.11-2404.CrossRefPubMedPubMedCentral

17.

Wang T, Yang SD, Huang WZ, Liu FY, Wang H, Ding WY. Factors predicting venous thromboembolism after spine surgery. Medicine (Baltimore). 2016;95(52):e5776. https://doi.org/10.1097/MD.0000000000005776.CrossRef

18.

Leizorovicz A. Epidemiology of post-operative venous thromboembolism in Asian patients. Results of the SMART venography study. Haematologica. 2007;92(9):1194–200. https://doi.org/10.3324/haematol.10819.CrossRefPubMed

19.

Park JH, Lee KE, Yu YM, Park YH, Choi SA. Incidence and risk factors for venous thromboembolism after spine surgery in Korean patients. World Neurosurgery. 2019;128:e289–307. https://doi.org/10.1016/j.wneu.2019.04.140.CrossRefPubMed

20.

Nieto J, Bruscas M, Ruiz-Ribo D, et al. Acute venous thromboembolism in patients with recent major bleeding. The influence of the site of bleeding and the time elapsed on outcome. J Thromb Haemost. 2006;4(11):2367–72.CrossRef

21.

Kim L, Kim JA, Kim S. A guide for the utilization of Health Insurance Review and Assessment Service national patient samples. Epidemiol Health. 2014;36:e2014008. https://doi.org/10.4178/epih/e2014008.CrossRefPubMedPubMedCentral

22.

Kim L, Kim JA, Kim S. A guide to the use of national patient samples. 2011. https://www.e-epih.org/journal/view.php?doi=10.4178/epih/e2014008. Accessed 19 Jan 2019.

23.

Patient Sample Data Set: Health Insurance Review & Assessment National Inpatient Sample in 2014. Health Insurance Review & Assessment Service. http://opendata.hira.or.kr/op/opc/selectPatDataAplInfoView.do. Accessed 14 Jan 2019.

24.

Awad JN, Kebaish KM, Donigan J, Cohen DB, Kostuik JP. Analysis of the risk factors for the development of post-operative spinal epidural haematoma. J Bone Joint Surgery British Volume. 2005;87(9):1248–52. https://doi.org/10.1302/0301-620X.87B9.16518.CrossRef

25.

ICD-9-CM Addenda, Conversion Table, and Guidelines. In: Center for Disease Control and Prevention/National Center for Health Statistics; 2013: https://www.cdc.gov/nchs/icd/icd9cm_addenda_guidelines.htm. Accessed 17 Aug 2018.

26.

StataCorp. Stata Statistical Software: Release 15. College Station: StataCorp LLC; 2017. https://www.stata.com/support/faqs/resources/citing-software-documentation-faqs/.

27.

Kou J, Fischgrund J, Biddinger A, Herkowitz H. Risk factors for spinal epidural hematoma after spinal surgery. Spine. 2002;27(15):1670–3.CrossRef

28.

Anno M, Yamazaki T, Hara N, Ito Y. The incidence, clinical features, and a comparison between early and delayed onset of postoperative spinal epidural hematoma. Spine. 2019;44(6):420.CrossRef

29.

Kebaish KM, Awad JN. Spinal epidural hematoma causing acute cauda equina syndrome. Neurosurgical focus. 2004;16(6):e1.PubMed

30.

Yamada K, Abe Y, Satoh S, Yanagibashi Y, Hyakumachi T, Masuda T. Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery. Spine. 2015;40(13):1046–52. https://doi.org/10.1097/brs.0000000000000876.CrossRefPubMed

31.

Agnelli G. Prevention of venous thromboembolism after neurosurgery. Thrombosis Haemostasis. 1999;82(2):925–30.PubMed

32.

Gerlach R, Raabe A, Beck J, Woszczyk A, Seifert V. Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery. Eur Spine J. 2004;13(1):9–13. https://doi.org/10.1007/s00586-003-0642-8.CrossRefPubMed

33.

Uribe J, Moza K, Jimenez O, Green B, Levi AD. Delayed postoperative spinal epidural hematomas. Spine J. 2003;3(2):125–9.CrossRef

34.

Kim JE, Choi DJ, Kim MC, Park EJ. Risk Factors of Postoperative Spinal Epidural Hematoma After Biportal Endoscopic Spinal Surgery. World Neurosurg. 2019. https://doi.org/10.1016/j.wneu.2019.05.141.CrossRef

35.

Ohba T, Ebata S, Haro H. Influence of postoperative hypertension on the development of spinal epidural hematoma. Orthopaedic Surg. 2017;9(4):386–90.CrossRef

36.

Goldstein CL, Bains I, Hurlbert RJ. Symptomatic spinal epidural hematoma after posterior cervical surgery: incidence and risk factors. Spine J. 2015;15(6):1179–87. https://doi.org/10.1016/j.spinee.2013.11.043.CrossRefPubMed

37.

Yi S, Yoon DH, Kim KN, Kim SH, Shin HC. Postoperative spinal epidural hematoma: risk factor and clinical outcome. Yonsei Med J. 2006;47(3):326–32. https://doi.org/10.3349/ymj.2006.47.3.326.CrossRefPubMedPubMedCentral

38.

Thiele RH, Hage ZA, Surdell DL, Ondra SL, Batjer HH, Bendok BR. Spontaneous spinal epidural hematoma of unknown etiology: case report and literature review. Neurocrit Care. 2008;9(2):242–6. https://doi.org/10.1007/s12028-008-9083-x.CrossRefPubMed

39.

Knusel K, Du JY, Ren B, Kim C-Y, Ahn UM, Ahn NU. Symptomatic epidural hematoma after elective posterior lumbar decompression: incidence, timing, risk factors, and associated complications. HSS Journal®. 2019:1–8. https://doi.org/10.1007/s11420-019-09690-2.

40.

Li H, Wang Z, Xu H, Sun J, Ning G, S F. Delayed spinal epidural hematoma after posterior cervical spine surgery: a case report. Int J Clin Exp Med. 2018;11(4):4226.

41.

Kao F-C, Tsai T-T, Chen L-H, et al. Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J. 2015;24(2):348–57. https://doi.org/10.1007/s00586-014-3297-8.CrossRefPubMed

42.

43.

Imajo Y, Taguchi T, Yone K, et al. Japanese 2011 nationwide survey on complications from spine surgery. J Orthop Sci. 2015;20(1):38–54. https://doi.org/10.1007/s00776-014-0656-6.CrossRefPubMed

44.

Yamada K, Abe Y, Satoh S, Yanagibashi Y, Hyakumachi T, Masuda T. Large increase in blood pressure after Extubation and high body mass index elevate the risk of spinal epidural hematoma after spinal surgery. Spine. 2015;40(13):1046–52. https://doi.org/10.1097/brs.0000000000000876.CrossRefPubMed

45.

Oecd. OECD Health Statistics 2014—Frequently Requested Data. 2014.

46.

Zhang T, Xu Y, Ren J, Sun L, Liu C. Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. Int J Equity Health. 2017;16(1):42. https://doi.org/10.1186/s12939-017-0543-9.CrossRefPubMedPubMedCentral

47.

48.

Mclynn RP, Diaz-Collado PJ, Ottesen TD, et al. Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery. Spine J. 2017. https://doi.org/10.1016/j.spinee.2017.10.013.CrossRef

49.

Mosenthal WP, LM J. Thromboprophylaxis in Spinal Surgery. Spine [Spine (Phila Pa 1976)]. 2018;43(8):E474–81. https://doi.org/10.1097/BRS.0000000000002379.CrossRef

Title: Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database
Authors: Ji Hyun Park
Sunny Park
Soo An Choi
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Anticoagulant
Epidural Hematoma
Published in: BMC Musculoskeletal Disorders / Issue 1/2020
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-020-03337-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer

Effects of short- and long-term glucocorticoid-induced osteoporosis on plasma metabolome and lipidome of ovariectomized sheep

A potential risk factor of total knee arthroplasty: an infected Baker’s cyst – a case report

Patient-related outcome, fracture displacement and bone mineral density following distal radius fracture in young and older men

Understanding cartilage protection in OA and injury: a spectrum of possibilities

Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation