The Risk and Outcomes of Epidural Hematomas After Perioperative and Obstetric Epidural Catheterization: A Report from the Multicenter Perioperative Outcomes Group Research Consortium
The Risk and Outcomes of Epidural Hematomas After Perioperative and Obstetric Epidural Catheterization: A Report from the Multicenter Perioperative Outcomes Group Research Consortium
复制标题
DOI：
10.1213/ane.0b013e318251daed
复制
发表时间：
2013-06-01
影响因子：
5.7
通讯作者：
Sandberg, Warren S.
中科院分区：
文献类型：
--
作者：
Bateman, Brian T.;Mhyre, Jill M.;Sandberg, Warren S.
背景：在本研究中，我们试图确定硬膜外导管插入术后硬膜外血肿的发生频率和结果。方法：参与多中心围手术期结果小组的 11 个中心使用电子麻醉信息系统和质量保证数据库来识别因产科或手术指征而插入硬膜外导管的患者。从该队列中，确定了在硬膜外放置后 6 周内接受椎板切除术以清除血肿的患者。 结果：62,450 名围术期接受硬膜外导管插入术的患者中有 7 名出现需要手术清除血肿的患者。事件率为11.2 x 10(-5)（95%置信区间[CI]，4.5 x 10(-5)至23.1 x 10(-5)）。 7 人中有 4 人接受了偏离美国区域麻醉学会指南的抗凝/抗血小板治疗。 79,837 名接受硬膜外导管插入术的产科患者均未出现血肿（95% CI 上限为 4.6 x 10(-5)）。产科硬膜外导管插入术中的血肿率显着低于围术期硬膜外导管插入术 (P = 0.003)。 结论：在本系列中，围手术期麻醉/镇痛硬膜外导管放置后需要椎板切除术的硬膜外血肿发生率的 95% CI 为每 22,189 次放置 1 次事件到每 4330 次放置 1 次事件。产科硬膜外麻醉的风险显着降低。
BACKGROUND: In this study, we sought to determine the frequency and outcomes of epidural hematomas after epidural catheterization.METHODS: Eleven centers participating in the Multicenter Perioperative Outcomes Group used electronic anesthesia information systems and quality assurance databases to identify patients who had epidural catheters inserted for either obstetrical or surgical indications. From this cohort, patients undergoing laminectomy for the evacuation of hematoma within 6 weeks of epidural placement were identified.RESULTS: Seven of 62,450 patients undergoing perioperative epidural catheterizations developed hematoma requiring surgical evacuation. The event rate was 11.2 x 10(-5)(95% confidence interval [CI], 4.5 x 10(-5) to 23.1 x 10(-5)). Four of the 7 had anticoagulation/antiplatelet therapy that deviated from American Society of Regional Anesthesia guidelines. None of 79,837 obstetric patients with epidural catheterizations developed hematoma (upper limit of the 95% CI, 4.6 x 10(-5)). The hematoma rate in obstetric epidural catheterizations was significantly lower than in perioperative epidural catheterizations (P = 0.003).CONCLUSIONS: In this series, the 95% CI for the frequency of epidural hematoma requiring laminectomy after epidural catheter placement for perioperative anesthesia/analgesia was 1 event per 22,189 placements to 1 event per 4330 placements. Risk was significantly lower in obstetric epidurals.