A meta-analysis of risk factors for symptomatic epidural hematoma after lumbar spine surgery

English Keywords:Lumbar surgery  Symptomatic epidural hematoma  Risk factors  Meta analysis

English Abstract:

  【Abstract】 Objectives: To analyze the risk factors of postoperative symptomatic epidural hematoma(PSEH) in patients undergoing lumbar spine surgery by systematic review. Methods: Case-control studies and cohort studies on the risk factors of PSEH in patients undergoing lumbar surgery were collected by searching PubMed, Embase, Web of Science, Cochrane Library, CBM, CNKI, Wanfang and VIP databases. The retrieval time limit was from the database construction to March 2022. Two researchers independently screened the literature and extracted the basic information, baseline characteristics and PSEH-related risk factors of the included studies, such as operation time, intraoperative blood loss, anticoagulant therapy and other outcome indicators and outcome measurement data. After evaluating the risk of bias in the included studies, RevMan 5.3 software was used for Meta-analysis. Results: A total of 17 studies were included, including 14 case-control studies and 3 cohort studies, involving 132,363 patients, and 525 of whom developed PSEH. The quality score of 16 out of 17 papers was all ≥6, and only 1 paper had a quality score of 5. Meta-analysis results showed that: Age ≥65 years [OR=3.36, 95%CI(2.13, 5.30), P=0.00001], preoperative platelet count[OR=1.89, 95%CI(1.31, 2.71), P=0.0006], combined hypertension[OR=1.50, 95%CI(1.22, 1.85), P=0.0001], use of hemostatic materials[OR=2.91，95%CI(1.93, 4.39), P<0.00001], coagulation disorder[OR=6.95, 95%CI (1.76, 27.43), P=0.006], revision surgery[OR=5.87, 95%CI(3.77, 9.12), P<0.00001], operative time ＞2h[OR=3.52, 95%CI (1.84, 6.71), P=0.0001], intraoperative blood loss ≥600ml[OR=3.77, 95%CI(1.31, 10.89), P=0.01], frozen plasma infusion[OR=8.13, 95%CI (4.46, 14.81), P<0.00001] and multilevel operation[OR=1.98, 95%CI(1.54, 2.56), P<0.00001] were independent risk factors for PSEH in patients with lumbar spine surgery. Conclusions: Current evidence indicates that age ≥65 years, preoperative thrombocytopenia, hypertension, use of hemostatic materials, coagulation disorders, revision surgery, operation time ＞2h, intraoperative blood loss ≥600ml, frozen plasma infusion, and multilevel surgery are the risk factors for PSEH in patients with lumbar spine surgery. In order to reduce the incidence of PSEH and improve the clinical prognosis, great attention should be paid and early intervention should be taken to high-risk patients with the above risk factors.