Analysis of the risk factors for the development of post-operative spinal epidural haematoma.
In order to identify the risk factors and the incidence of post-operative spinal epidural haematoma, we analysed the records of 14 932 patients undergoing spinal surgery between 1984 and 2002. Of these, 32 (0.2%) required re-operation within one week of the initial procedure and had an International Classification of Diseases (ICD)-9 code for haematoma complicating a procedure (998.12). As controls, we selected those who had undergone a procedure of equal complexity by the same surgeon but who had not developed this complication. Risks identified before operation were older than 60 years of age, the use of pre-operative non-steroidal anti-inflammatories and Rh-positive blood type. Those during the procedure were involvement of more than five operative levels, a haemoglobin < 10 g/dL, and blood loss > 1 L, and after operation an international normalised ratio > 2.0 within the first 48 hours. All these were identified as significant (p < 0.03). Well-controlled anticoagulation and the use of drains were not associated with an increased risk of post-operative spinal epidural haematoma.
Awad
J N
JN
Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, A672, Baltimore, Maryland 21224, USA.
Kebaish
K M
KM
Donigan
J
J
Cohen
D B
DB
Kostuik
J P
JP
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000209:etiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology*; D012189:Retrospective Studies; D012204:Rh-Hr Blood-Group System; D012307:Risk Factors; D013131:Spine / Q000601:surgery*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D006454:Hemoglobins; D012204:Rh-Hr Blood-Group System