Spinal epidural hematoma and abscess after neuraxial anesthesia: a historical cohort study using the Japanese Diagnosis
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REPORTS OF ORIGINAL INVESTIGATIONS
Spinal epidural hematoma and abscess after neuraxial anesthesia: a historical cohort study using the Japanese Diagnosis Procedure Combination database He´matomes et abce`s pe´riduraux apre`s une anesthe´sie neuraxiale : une e´tude de cohorte historique fonde´e sur la base de donne´es japonaise DPC Kanako Makito, MD, MPH . Hideyuki Mouri, MD, MPH . Hiroki Matsui, MPH . Nobuaki Michihata, MD, PhD . Kiyohide Fushimi, MD, PhD . Hideo Yasunaga, MD, PhD Received: 23 January 2020 / Revised: 12 July 2020 / Accepted: 13 July 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Background 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. Methods 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. K. Makito, MD, MPH (&) H. Matsui, MPH N. Michihata , MD, PhD H. Yasunaga, MD, PhD Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan e-mail: [email protected] H. Mouri, MD, MPH Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan K. Fushimi, MD, PhD Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo, Medical and Dental University, Tokyo, Japan
Results 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. Conclusions 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. Re´sume´ Contexte Les he´matomes et abce`s pe´riduraux sont des complications rares de l’anesthe´sie neuraxiale qui
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