Late-presenting dural tear: incidence, threat elements, and related issues.
Backbone J. 2018 Apr 18;:
Authors: Durand WM, DePasse JM, Kuris EO, Yang J, Daniels AH
BACKGROUND CONTEXT: Unrecognized and inadequately repaired intraoperative durotomies might result in cerebrospinal fluid leak, pseudomeningocele, and different issues. Few research have investigated durotomy that’s unrecognized intraoperatively and requires extra postoperative administration (hereafter, late-presenting dural tear [LPDT]), although estimates of LPDT vary from zero.6 – eight.three per 1,000 spinal surgical procedures. These single-center research are primarily based on comparatively small pattern sizes for an occasion of this rarity, all with <10 sufferers experiencing LPDT.
PURPOSE: This investigation is the biggest but performed on LPDT, and sought to establish incidence, threat elements for, and issues related to LPDT.
STUDY DESIGN/SETTING: This observational cohort research employed the ACS NSQIP dataset (years 2012 – 2015).
PATIENT SAMPLE: Sufferers present process backbone surgical procedure have been recognized primarily based on presence of main listed CPT codes comparable to spinal fusion or remoted posterior decompression with out fusion.
OUTCOME MEASURES: The first variable on this research was prevalence of late-presenting dural tear, recognized as reoperation or readmission with durotomy-specific CPT or ICD-9-CM codes however with out durotomy codes current for the index process.
METHODS: Descriptive statistics have been generated. Bivariate and multivariate analyses have been performed utilizing Chi-Sq. checks and a number of logistic regression, respectively, producing each threat elements for LPDT and impartial affiliation of LPDT with postoperative issues. Statistical significance was outlined as p<zero.05. No funding was obtained in assist of this research. The authors report no related conflicts of curiosity.
RESULTS: In complete, 86,212 sufferers have been analyzed. The general price of reoperation or readmission with out reoperation for LPDT was 2.zero per 1,000 sufferers (n=174). 97.7% of LPDT sufferers required a number of unplanned reoperations (n=170), and 5.7% of sufferers (n=10) required two reoperations. On multivariate evaluation, lumbar procedures (odds ratio [OR] 2.79, p<zero.0001, vs. cervical), procedures involving each cervical and lumbar ranges (OR three.78, p=zero.0338, vs. cervical solely), procedures with decompression solely (OR 1.72, p=zero.0017, vs. fusion and decompression), and operative period ?250 minutes (OR 1.70, p=zero.0058, vs. <250 minutes) have been related to elevated probability of LPDT. LPDT was considerably related to surgical website an infection (SSI) (OR 2.54, p<zero.0001), wound disruption (OR 2.24, p<zero.0001), sepsis (OR 2.19, p<zero.0001), thromboembolism (OR 1.71, p<zero.0001), acute kidney damage (OR 1.59, p=zero.0281), pneumonia (OR 1.14, p=zero.0269), and urinary tract an infection (UTI) (OR 1.08, p=zero.0057).
CONCLUSIONS: Late-presenting dural tears occurred in 2.zero per 1,000 backbone surgical procedure sufferers. Sufferers present process lumbar procedures, decompression procedures, and procedures with operative period ?250 minutes have been at elevated threat for LPDT. Additional, LPDT was independently related to elevated probability of SSI, sepsis, pneumonia, UTI, wound dehiscence, thromboembolism, and acute kidney damage. As LPDT is related to markedly elevated morbidity and potential legal responsibility threat, backbone surgeons ought to concentrate on best-practice administration for LPDT and take into account it as a uncommon, however potential etiology for growing postoperative issues.
PMID: 29679726 [PubMed – as supplied by publisher]