Symptomatic Epidural Hematoma After Elective Cervical Spine Surgery: Incidence, Timing, Risk Factors, and Associated Complications

2021 ◽  
Author(s):  
Matthew V Abola ◽  
Jerry Y Du ◽  
Charles C Lin ◽  
William Schreiber-Stainthorp ◽  
Peter G Passias
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Spine Surgery ◽  
International Classification Of Diseases ◽  
Improvement Program ◽  
Cervical Spine Surgery ◽  
Vein Thrombosis ◽  
Postoperative Hematoma ◽  
Classification Of Diseases ◽  
American Society

Abstract BACKGROUND As the rate of elective cervical spine surgery increases, studies of complications may improve quality of care. Symptomatic postoperative cervical epidural hematomas (PCEH) are rare but result in significant morbidity. Because of their low incidence, the risk factors and complications associated with symptomatic PCEH remain unclear. OBJECTIVE To clarify the prevalence, timing, variables, and complications associated with PCEH following elective cervical spine surgery. METHODS Using the American College of Surgeons National Surgical Quality Improvement Program database, cervical spine surgeries performed between 2012 and 2016 were identified using Current Procedural Terminology codes. Symptomatic PCEH was defined as readmission or reoperation events specifically associated with International Classification of Diseases code diagnoses of postoperative hematoma within 30 d of index surgery. Multivariate models were created to assess the independent association of symptomatic PCEH with other postoperative complications. RESULTS There were 53233 patients included for analysis. The overall incidence of symptomatic PCEH was 0.4% (n = 198). Reoperation occurred in 158 cases (78.8%), of which 2 required a second reoperation (1.3%). The majority (91.8%) of hematomas occurred within 15 d of surgery. Multivariate analysis identified male gender, American Society of Anesthesiologists classes 3 to 5, bleeding disorder, increasing number of operative levels, revision surgery, dural repair, and perioperative transfusion as independent factors associated with PCEH. Upon controlling for those confounders, PCEH was independently associated with cardiac arrest, stroke, deep vein thrombosis, surgical site infection, and pneumonia. CONCLUSION Postoperative epidural hematomas requiring readmission or reoperation following elective cervical spine surgery occurred at an incidence of 0.4%. Symptomatic PCEHs are associated with increased rates of numerous major morbidities.

scholarly journals Orthostatic Hypotension Following Cervical Spine Surgery: Prevalence and Risk Factors

2019 ◽  
Vol 10 (5) ◽  
pp. 578-582
Author(s):  
Edward Tien-En Ong ◽  
Lincoln Kai-Pheng Yeo ◽  
Arun-Kumar Kaliya-Perumal ◽  
Jacob Yoong-Leong Oh
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Orthostatic Hypotension ◽  
Functional Status ◽  
Spine Surgery ◽  
Surgical Approach ◽  
Mechanism Of Injury ◽  
Medical Comorbidities ◽  
Cervical Spine Surgery ◽  
Cord Injury

Study Design: Retrospective case series. Objectives: This study aims to determine the prevalence and risk factors for orthostatic hypotension (OH) in patients undergoing cervical spine surgery. Methods: Data was collected from records of 190 consecutive patients who underwent cervical spine procedures at our center over 24 months. Statistical comparison was made between patients who developed postoperative OH and those who did not by analyzing characteristics such as age, gender, premorbid medical comorbidities, functional status, mechanism of spinal cord injury, preoperative neurological function, surgical approach, estimated blood loss, and length of stay. Results: Twenty-two of 190 patients (11.6%) developed OH postoperatively. No significant differences in age, gender, medical comorbidities, or premorbid functional status were observed. Based on univariate comparisons, traumatic mechanism of injury ( P = .002), poor ASIA (American Spinal Injury Association) grades (A, B, or C) ( P < .001), and posterior surgical approach ( P = .045) were found to significantly influence occurrence of OH. Among the significant variables, after adjusting for mechanism of injury and surgical approach, only ASIA grade was found to be an independent predictor. Having an ASIA grade of A, B, or C increased the likelihood of developing OH by approximately 5.978 times ( P = .003). Conclusion: Our study highlights that OH is not an uncommon manifestation following cervical spine surgery. Patients with poorer ASIA grades A, B, or C were more likely to have OH when compared with those with ASIA grades D or E (43.5% vs 7.2%). Hence, we suggest that postural blood pressure should be routinely monitored in this group of patients so that early intervention can be initiated.

scholarly journals Incidence and Risk Factors of Postoperative Delirium in Cervical Spine Surgery

Spine ◽  
2009 ◽  
Vol 34 (23) ◽  
pp. 2500-2504 ◽  
Author(s):  
Takahiro Ushida ◽  
Takeshi Yokoyama ◽  
Yasuyo Kishida ◽  
Mika Hosokawa ◽  
Shinichirou Taniguchi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Postoperative Delirium ◽  
Cervical Spine Surgery

scholarly journals Frequency, recognition, and management of postoperative hematomas following anterior cervical spine surgery: A review

2020 ◽  
Vol 11 ◽  
pp. 356
Author(s):  
Nancy Epstein
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Early Recognition ◽  
Case Reports ◽  
Case Series ◽  
Improvement Program ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Cervical Surgery ◽  
Anterior Corpectomy

Background: We reviewed the frequency, recognition, and management of postoperative hematomas (HT) (i.e. retropharyngeal [RFH], wound [WH], and/or spinal epidural hematomas [SEH]) following anterior cervical discectomy/fusion (ACDF), anterior corpectomy fusion (ACF), and/or anterior cervical spine surgery (ACSS). Methods: Postoperative cervical hematomas following ACDF, ACF, and ACSS ranged from 0.4% to 1.2% in a series of 11 studies involving a total of 44, 030 patients. These included; 4 single case reports, 2 small case series (6 and 30 cases), 4 larger series (758–2375 for a total of 6729 patients), an a large NSQUIP (National Surgical Quality Improvement Program ) Database involving 37,261 ACDF patients. Results: Risk factors contributing to postoperative cervical hematomas included; DISH (diffuse idiopathic skeletal hyperostosis), ossification of the posterior longitudinal ligament (OPLL), therpeutic heparin levels, longer operative times, multilevel surgery, ASA Scores of +/= 3, (American Society of Anesthesiologists), prone surgery, operative times > 4 hours, smoking, higher/lower body mass index (BMI), anemia, age >65, > medical comorbidities, and male gender. Notably, the use of drains did not prevent HT, and did not increase the infection, or reoperation rates. Conclusion: In our review of 11 studies focused on anterior cervical surgery, the incidence of postoperative hematomas ranged from 0.4 to 1.2%. Early recognition of these postoperative hemorrhages, and appropriate management (surgical/non-surgical) are critical to optimize recovery, and limit morbidity, and mortality.

scholarly journals Risk Factor Analysis of Perioperative Complications in Patients with Rheumatoid Arthritis Undergoing Primary Cervical Spine Surgery

2021 ◽  
Author(s):  
Koji Sakuraba ◽  
Yuki Omori ◽  
Kazuhiro Kai ◽  
Kazumasa Terada ◽  
Nobuo Kobara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Perioperative Complications ◽  
High Dose ◽  
Cervical Spine Surgery ◽  
Lower Height

Abstract Background: Rheumatoid arthritis (RA) often causes cervical spine lesions as the disease condition progresses, which induce occipital neuralgia or cervical myelopathy requiring surgical interventions. Meanwhile, patients with RA are susceptible to infection or other complications in the perioperative period because they frequently have comorbidities and use immunosuppressive medications. However, the risk factors or characteristics of patients with RA who experience perioperative complications after cervical spine surgery remain unknown. A risk factor analysis of perioperative complications in patients with RA who underwent primary cervical spine surgery was conducted in the present study.Methods: A total of 139 patients with RA who underwent primary cervical spine surgery from January 2001 to March 2020 were retrospectively investigated. Age and height, weight, serum albumin, serum C-reactive protein, American Society of Anesthesiologists Physical Status (ASA-PS), Charlson comorbidity index, medications used, cervical spine lesion, surgery time, bleeding volume, and procedures were collected from medical records to compare the patients with complications to those without complications after surgery. The risk factors for perioperative complications were assessed by univariate and multivariate logistic regression analysis.Results: Twenty-eight patients (20.1%) had perioperative complications. Perioperative complications were significantly associated with the following factors [data presented as odds ratio (confidence interval)]: lower height [0.928 (0.880-0.980), p=0.007], higher ASA-PS [2.296 (1.007-5.235), p=0.048], longer operation time [1.013 (1.004-1.021), p=0.003], more bleeding volume [1.004 (1.000-1.007), p=0.04], higher rates of vertical subluxation [2.914 (1.229-6.911), p=0.015] and subaxial subluxation (SAS) [2.507 (1.063-5.913), p=0.036], occipito-cervical (OC) fusion [3.438 (1.189-9.934), p=0.023], and occipito-cervical/thoracic (long) fusion [8.021 (2.145-29.99), p=0.002] in univariate analyses. In multivariate analyses, lower height [0.915 (0.860-0.974), p=0.005], higher ASA-PS [2.622 (1.023-6.717), p=0.045] and long fusion [7.289 (1.694-31.36), p=0.008] remained risk factors. High-dose prednisolone use [1.247 (1.024-1.519), p=0.028], SAS [6.413 (1.381-29.79), p=0.018], OC fusion [17.93 (1.242-258.8), p=0.034] and long fusion [108.1 (6.876-1699), p<0.001] were associated with severe complications.Conclusions: ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications.

Adverse events and their risk factors 90 days after cervical spine surgery: analysis from the Michigan Spine Surgery Improvement Collaborative

2019 ◽  
Vol 30 (5) ◽  
pp. 602-614 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Michael Bazydlo ◽  
Lonni Schultz ◽  
Markian A. Pahuta ◽  
Jason M. Schwalb ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Adverse Events ◽  
Urinary Retention ◽  
Spine Surgery ◽  
Anterior Approach ◽  
Private Insurance ◽  
Foraminal Stenosis ◽  
Cervical Spine Surgery ◽  
Discharge Disposition

OBJECTIVEThe Michigan Spine Surgery Improvement Collaborative (MSSIC) is a statewide, multicenter quality improvement initiative. Using MSSIC data, the authors sought to identify 90-day adverse events and their associated risk factors (RFs) after cervical spine surgery.METHODSA total of 8236 cervical spine surgery cases were analyzed. Multivariable generalized estimating equation regression models were constructed to identify RFs for adverse events; variables tested included age, sex, diabetes mellitus, disc herniation, foraminal stenosis, central stenosis, American Society of Anesthesiologists Physical Classification System (ASA) class > II, myelopathy, private insurance, anterior versus posterior approach, revision procedures, number of surgical levels, length of procedure, blood loss, preoperative ambulation, ambulation day of surgery, length of hospital stay, and discharge disposition.RESULTSNinety days after cervical spine surgery, adverse events identified included radicular findings (11.6%), readmission (7.7%), dysphagia requiring dietary modification (feeding tube or nothing by mouth [NPO]) (6.4%), urinary retention (4.7%), urinary tract infection (2.2%), surgical site hematoma (1.1%), surgical site infection (0.9%), deep vein thrombosis (0.7%), pulmonary embolism (0.5%), neurogenic bowel/bladder (0.4%), myelopathy (0.4%), myocardial infarction (0.4%), wound dehiscence (0.2%), claudication (0.2%), and ileus (0.2%). RFs for dysphagia included anterior approach (p < 0.001), fusion procedures (p = 0.030), multiple-level surgery when considering anterior procedures only (p = 0.037), and surgery duration (p = 0.002). RFs for readmission included ASA class > II (p < 0.001), while preoperative ambulation (p = 0.001) and private insurance (p < 0.001) were protective. RFs for urinary retention included increasing age (p < 0.001) and male sex (p < 0.001), while anterior-approach surgery (p < 0.001), preoperative ambulation (p = 0.001), and ambulation day of surgery (p = 0.001) were protective. Preoperative ambulation (p = 0.010) and anterior approach (p = 0.002) were protective of radicular findings.CONCLUSIONSA multivariate analysis from a large, multicenter, prospective database identified the common adverse events after cervical spine surgery, along with their associated RFs. This information can lead to more informed surgeons and patients. The authors found that early mobilization after cervical spine surgery has the potential to significantly decrease adverse events.

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