A meta-analysis of risk factors for postoperative epidural hematoma in patients undergoing cervical spinal surgery

English Keywords:Cervical surgery  Epidural hematoma  Risk factors  Meta analysis

English Abstract:

  【Abstract】 Objectives: To systematically evaluate the risk factors associated with postoperative epidural hematoma in patients undergoing cervical spinal surgery. Methods: PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang databases, VIP databases and CBM were searched by computer for retrospective or prospective studies on epidural hematoma in patients undergoing cervical spine surgery published since the inception of the databases to April 2023. Two reviewers screened the literatures according to the inclusion and exclusion criteria, and NOS scale was used to evaluate the quality of the literature included. The basic information of the study, including age, gender and body mass index(BMI), as well as the factors related to the occurrence of epidural hematoma after cervical spine surgery, such as surgical segment, whether combined with posterior longitudinal ligament ossification, operative time, diabetes, hypertension, smoking, use of non-steroidal anti-inflammatory drugs and laboratory related indicators were extracted. The risk of bias analysis of the included studies was performed using funnel plots, and meta-analysis was performed using RevMan 5.4 software. Results: A total of 12 literatures were included, and the NOS quality scores of the included literatures were all 6-8 points, of which, 11 were of high quality and 1 was of medium quality. Meta-analysis showed that male[odds ratio(OR)=2.84, 95% confidence interval(CI)(1.73, 4.67), P＜0.0001], BMI＞24kg/m2 [OR=8.50, 95%CI(2.56, 25.24), P=0.0005], multiple surgical segments(≥2) [OR=2.26, 95%CI(1.42, 3.594), P=0.0005], operative time>2h[OR=1.46, 95%CI(1.08, 1.97), P=0.01], preoperative administration of nonsteroidal anti-inflammatory drugs[OR=3.60, 95% CI(1.00, 12.99), P=0.05] were the risk factors for epidural hematoma after cervical spine surgery. The results of the funnel plot were used to test the publication bias of the surgical segment and intraoperative blood loss, which were the most influential factors in the literature, and the results showed that there was no publication bias in the surgical segment, while there was partial publication bias in the intraoperative blood loss. Conclusions: Male, BMI＞24kg/m2, multi-segment surgery(surgical segment≥2), operative time>2h, and preoperative administration of nonsteroidal anti-inflammatory drugs are the risk factors for SEH after cervical spine surgery.