Abstract
BackgroundWith 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.MethodsA 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.ResultsThe 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.ConclusionAlthough 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.
Highlights
With increasing number of patients undergoing spine surgery, the spinal epidural hemorrhage (SEH) has become a growing concern
Spine surgery and SEH case estimation Based on the inpatient records, out of a total of 31,964, 373 cases, there were 17,549 cases of spinal surgery in 2014
We found that most independent variables that have been included in the study model were associated with the incidence rate of SEH
Summary
With increasing number of patients undergoing spine surgery, the spinal epidural hemorrhage (SEH) has become a growing concern. There are a number of reasons, such as an increased incidence of obesity, degenerative spinal conditions, and an aging population seeking better quality of life, for this increase [2]. It has Spinal epidural hemorrhage (SEH) manifests a bleeding in the epidural space along the spinal canal [3]. Stimulation that results in hemorrhage around the spinal cord may cause SEH; these include trauma, surgeries, tumors, use of anticoagulants, or invasive neurological procedures. Symptomatic SEH causing permanent neurologic deficit rarely develops, and the reported incidence rate is between 0 and 3%. Far less is known on the Asian population including South Korea and Japan regarding all types of SEH, and even the exclusive diagnostic code for SEH has not yet been established [9, 10]
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