Verma Ketan, Freelin Anne H, Atkinson Kelsey A, Graham Robert S, Broaddus William C
J Neurosurg Spine. 2022 Mar 18;37(3):460-465. doi: 10.3171/2022.1.SPINE211208. Print 2022 Sep 1.
The aim of this study was to assess whether flat bed rest for > 24 hours after an incidental durotomy improves patient outcome or is a risk factor for medical and wound complications and longer hospital stay.
Medical records of consecutive patients undergoing thoracic and lumbar decompression procedures from 2010 to 2020 were reviewed. Operative notes and progress notes were reviewed and searched to identify patients in whom incidental durotomies occurred. The need for revision surgery related to CSF leak or wound infection was recorded. The duration of bed rest, length of hospital stay, and complications (pulmonary, gastrointestinal, urinary, and wound) were recorded. The rates of complications were compared with regard to the duration of bed rest (≤ 24 hours vs > 24 hours).
A total of 420 incidental durotomies were identified, indicating a rate of 6.7% in the patient population. Of the 420 patients, 361 underwent primary repair of the dura; 254 patients were prescribed bed rest ≤ 24 hours, and 107 patients were prescribed bed rest > 24 hours. There was no statistically significant difference in the need for revision surgery (7.87% vs 8.41%, p = 0.86) between the two groups, but wound complications were increased in the prolonged bed rest group (8.66% vs 15.89%, p = 0.043). The average length of stay for patients with bed rest ≤ 24 hours was 4.47 ± 3.64 days versus 7.24 ± 4.23 days for patients with bed rest > 24 hours (p < 0.0001). There was a statistically significant increase in the frequency of ileus, urinary retention, urinary tract infections, pulmonary issues, and altered mental status in the group with prolonged bed rest after an incidental durotomy. The relative risk of complications in the group with bed rest ≤ 24 hours was 50% less than the group with > 24 hours of bed rest (RR 0.5, 95% CI 0.39-0.62; p < 0.0001).
In this retrospective study, the rate of revision surgery was not higher in patients with durotomy who underwent immediate mobilization, and medical complications were significantly decreased. Flat bed rest > 24 hours following incidental durotomy was associated with increased length of stay and increased rate of medical complications. After primary repair of an incidental durotomy, flat bed rest may not be necessary and appears to be associated with higher costs and complications.
本研究旨在评估意外硬脊膜切开术后卧床休息超过24小时是否能改善患者预后，或者是否是导致医疗和伤口并发症以及延长住院时间的危险因素。
回顾了2010年至2020年接受胸腰椎减压手术的连续患者的病历。查阅手术记录和病程记录以确定发生意外硬脊膜切开术的患者。记录与脑脊液漏或伤口感染相关的翻修手术需求。记录卧床休息时间、住院时间和并发症（肺部、胃肠道、泌尿系统和伤口）情况。比较卧床休息时间（≤24小时与>24小时）的并发症发生率。
共确定420例意外硬脊膜切开术，在患者群体中的发生率为6.7%。420例患者中，361例行硬脊膜初次修复；254例患者被规定卧床休息≤24小时，107例患者被规定卧床休息>24小时。两组之间翻修手术需求无统计学显著差异（7.87%对8.41%，p = 0.86），但长期卧床休息组的伤口并发症增加（8.66%对15.89%，p = 0.043）。卧床休息≤24小时患者的平均住院时间为4.47±3.64天，而卧床休息>24小时患者为7.24±4.23天（p < 0.0001）。意外硬脊膜切开术后长期卧床休息组的肠梗阻、尿潴留、尿路感染、肺部问题和精神状态改变的发生率有统计学显著增加。卧床休息≤24小时组并发症的相对风险比>24小时卧床休息组低50%（RR 0.5，95%CI 0.39 - 0.62；p < 0.0001）。
在这项回顾性研究中，立即活动的硬脊膜切开术患者的翻修手术率并不更高，且医疗并发症显著减少。意外硬脊膜切开术后卧床休息超过24小时与住院时间延长和医疗并发症发生率增加相关。意外硬脊膜切开术初次修复后，可能无需卧床休息，而且似乎与更高的成本和并发症相关。
