title: The risk and outcomes of epidural hematomas after perioperative and obstetric epidural catheterization: a report from the Multicenter Perioperative Outcomes Group Research Consortium.
abstract: BACKGROUND
  In this study, we sought to determine the frequency and outcomes of epidural hematomas after epidural catheterization.
  
  
  METHODS
  Eleven centers participating in the Multicenter Perioperative Outcomes Group used electronic anesthesia information systems and quality assurance databases to identify patients who had epidural catheters inserted for either obstetrical or surgical indications. From this cohort, patients undergoing laminectomy for the evacuation of hematoma within 6 weeks of epidural placement were identified.
  
  
  RESULTS
  Seven of 62,450 patients undergoing perioperative epidural catheterizations developed hematoma requiring surgical evacuation. The event rate was 11.2 × 10(-5) (95% confidence interval [CI], 4.5 × 10(-5) to 23.1 × 10(-5)). Four of the 7 had anticoagulation/antiplatelet therapy that deviated from American Society of Regional Anesthesia guidelines. None of 79,837 obstetric patients with epidural catheterizations developed hematoma (upper limit of the 95% CI, 4.6 × 10(-5)). The hematoma rate in obstetric epidural catheterizations was significantly lower than in perioperative epidural catheterizations (P = 0.003).
  
  
  CONCLUSIONS
  In this series, the 95% CI for the frequency of epidural hematoma requiring laminectomy after epidural catheter placement for perioperative anesthesia/analgesia was 1 event per 22,189 placements to 1 event per 4330 placements. Risk was significantly lower in obstetric epidurals.
authors.affiliation: Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St., Boston, MA 02114, USA. BBateman@partners.org
authors.forename: Brian T
authors.initials: BT
authors.lastname: Bateman
authors.forename: Jill M
authors.initials: JM
authors.lastname: Mhyre
authors.forename: Jesse
authors.initials: J
authors.lastname: Ehrenfeld
authors.forename: Sachin
authors.initials: S
authors.lastname: Kheterpal
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Abbey
authors.forename: Maged
authors.initials: M
authors.lastname: Argalious
authors.forename: Mitchell F
authors.initials: MF
authors.lastname: Berman
authors.forename: Paul St
authors.initials: PS
authors.lastname: Jacques
authors.forename: Warren
authors.initials: W
authors.lastname: Levy
authors.forename: Robert G
authors.initials: RG
authors.lastname: Loeb
authors.forename: William
authors.initials: W
authors.lastname: Paganelli
authors.forename: Kelly W
authors.initials: KW
authors.lastname: Smith
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Wethington
authors.forename: David
authors.initials: D
authors.lastname: Wax
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Pace
authors.forename: Kevin
authors.initials: K
authors.lastname: Tremper
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D002404:Catheterization / Q000009:adverse effects*; D005260:Female; D046748:Hematoma, Epidural, Spinal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008875:Middle Aged; D059035:Perioperative Period; D011247:Pregnancy; D012306:Risk