Anesthesiology. 2021 Jun 1;134(6):925-936. doi: 10.1097/ALN.0000000000003770.
Deep spinal infection is a devastating complication after epidural injection. This study aimed to investigate the incidence of deep spinal infection primarily after outpatient single-shot epidural injection for pain. Secondarily, this study assessed the national trends of the procedure and risk factors for said infection.
Using South Korea's National Health Insurance Service sample cohort database, the 10-yr national trend of single-shot epidural injections for pain and the incidence rate of deep spinal infection after the procedure with its risk factors were determined. New-onset deep spinal infections were defined as those occurring within 90 days of the most recent outpatient single-shot epidural injection for pain, needing hospitalization for at least 1 night, and receiving at least a 4-week course of antibiotics.
The number of outpatient single-shot epidural injections per 1,000 persons in pain practice doubled from 40.8 in 2006 to 84.4 in 2015 in South Korea. Among the 501,509 injections performed between 2007 and 2015, 52 cases of deep spinal infections were detected within 90 days postprocedurally (0.01% per injection). In multivariable analysis, age of 65 yr or more (odds ratio, 2.91; 95% CI, 1.62 to 5.5; P = 0.001), living in a rural area (odds ratio, 2.85; 95% CI, 1.57 to 5.0; P < 0.001), complicated diabetes (odds ratio, 3.18; 95% CI, 1.30 to 6.7; P = 0.005), multiple epidural injections (three times or more) within the previous 90 days (odds ratio, 2.34; 95% CI, 1.22 to 4.2; P = 0.007), and recent use of immunosuppressants (odds ratio, 2.90; 95% CI, 1.00 to 6.7; P = 0.025) were significant risk factors of the infection postprocedurally.
The incidence of deep spinal infection after outpatient single-shot epidural injections for pain is very rare within 90 days of the procedure (0.01%). The data identify high-risk patients and procedure characteristics that may inform healthcare provider decision-making.
硬膜外注射后发生深部脊髓感染是一种毁灭性的并发症。本研究旨在调查主要在门诊单次硬膜外注射治疗疼痛后发生深部脊髓感染的发生率。其次，本研究评估了该程序的全国趋势和感染的危险因素。
利用韩国国家健康保险服务样本队列数据库，确定了 10 年来用于治疗疼痛的单次硬膜外注射的全国趋势以及该程序后深部脊髓感染的发生率及其危险因素。新发深部脊髓感染定义为在最近一次门诊单次硬膜外注射治疗疼痛后 90 天内发生的感染，需要住院至少 1 晚，并接受至少 4 周的抗生素治疗。
韩国每 1000 名疼痛患者接受的门诊单次硬膜外注射人数从 2006 年的 40.8 人增加到 2015 年的 84.4 人。在 2007 年至 2015 年期间进行的 501509 次注射中，52 例在术后 90 天内出现深部脊髓感染（每注射 0.01%）。多变量分析显示，65 岁或以上（比值比，2.91；95%可信区间，1.62 至 5.5；P = 0.001）、居住在农村地区（比值比，2.85；95%可信区间，1.57 至 5.0；P < 0.001）、合并糖尿病（比值比，3.18；95%可信区间，1.30 至 6.7；P = 0.005）、在过去 90 天内进行三次或更多次硬膜外注射（比值比，2.34；95%可信区间，1.22 至 4.2；P = 0.007）和近期使用免疫抑制剂（比值比，2.90；95%可信区间，1.00 至 6.7；P = 0.025）是术后感染的显著危险因素。
在术后 90 天内，门诊单次硬膜外注射治疗疼痛后发生深部脊髓感染的发生率非常低（0.01%）。这些数据确定了高风险患者和可能影响医疗服务提供者决策的程序特征。
