Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan.
Can J Anaesth. 2021 Jan;68(1):42-52. doi: 10.1007/s12630-020-01827-w. Epub 2020 Oct 9.
Spinal epidural hematoma and abscess are rare complications of neuraxial anesthesia but can cause severe neurologic deficits. The incidence of these complications vary widely in existing studies and the risk factors remain uncertain. We estimated the incidence of these complications and explored associations using a national inpatient database in Japan.
Using Japanese Diagnosis Procedure Combination data on surgical inpatients who underwent neuraxial anesthesia from July 2010 to March 2017, we identified patients with spinal epidural hematoma and/or abscess. We investigated age, sex, Charlson comorbidity index, antithrombotic therapy, type of surgery, admission, and hospital for association with these complications. The incidences of spinal epidural hematoma and abscess were estimated separately, and a nested case-control study was performed to examine factors associated with these complications.
We identified 139 patients with spinal epidural hematoma and/or abscess among 3,833,620 surgical patients undergoing neuraxial anesthesia. The incidences of spinal epidural hematoma and abscess were 27 (95% confidence interval [CI], 22 to 32) and 10 (7 to 13) per one million patients, respectively. Spinal anesthesia was associated with significantly fewer complications compared with epidural or combined spinal epidural anesthesia (odds ratio, 0.15; 95% CI, 0.08 to 0.32). Antiplatelet agent (odds ratio, 0.49; 95% CI, 0.06 to 3.91) and anticoagulants (odds ratio, 1.65; 95% CI, 0.95 to 2.85) were not significantly associated with these complications.
This analysis identified the incidences of spinal epidural hematoma and/or abscess after neuraxial anesthesia. Additional large-scale studies are warranted to examine the incidences and factors associated with these complications.
脊柱硬膜外血肿和脓肿是椎管内麻醉的罕见并发症，但可导致严重的神经功能缺损。这些并发症的发生率在现有研究中差异很大，其危险因素仍不确定。我们使用日本全国住院患者数据库估计了这些并发症的发生率，并进行了相关研究。
我们使用日本 2010 年 7 月至 2017 年 3 月接受椎管内麻醉的手术住院患者的诊断程序组合数据，确定了患有脊柱硬膜外血肿和/或脓肿的患者。我们调查了年龄、性别、Charlson 合并症指数、抗血栓治疗、手术类型、入院和住院医院与这些并发症的关系。分别估计了脊柱硬膜外血肿和脓肿的发生率，并进行了嵌套病例对照研究，以检查与这些并发症相关的因素。
我们在 3833620 名接受椎管内麻醉的手术患者中发现了 139 例脊柱硬膜外血肿和/或脓肿患者。脊柱硬膜外血肿和脓肿的发生率分别为 27（95%置信区间[CI]，22 至 32）和 10（7 至 13）每百万患者。与硬膜外或联合脊髓硬膜外麻醉相比，脊髓麻醉与并发症显著减少相关（比值比，0.15；95%CI，0.08 至 0.32）。抗血小板药物（比值比，0.49；95%CI，0.06 至 3.91）和抗凝剂（比值比，1.65；95%CI，0.95 至 2.85）与这些并发症无显著相关性。
本分析确定了椎管内麻醉后脊柱硬膜外血肿和/或脓肿的发生率。需要进一步进行大规模研究，以检查这些并发症的发生率和相关因素。
