Incidental dural tear in spine surgery: analysis of a nationwide database

Abstract

Purpose The purpose of this study was to report the incidence of dural tear (DT) in spine surgery, risk factors, and patient outcomes on a national level. Methods Clinical data were obtained from the Nationwide Inpatient Sample for 2009. Patients who underwent spine surgery were identified and, among them, patients who had DT were identified, according to the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes. Patient and hospital demographic data were retrieved. The incidence of DT and inhospital patient outcomes were analyzed. Multivariate logistic regression analysis was performed to identify the risk factors for DT. Results The incidence of DT was 2.7 % (17,932/ 665,818). Multivariate analysis revealed that older age, female gender, increased Elixhauser comorbidity score, and high hospital caseload were the significant risk factors for DT. Comparison between patients with and without DT showed that those with DT had significantly higher overall in-hospital complications (18.8 vs. 10.2 %), higher inhospital mortality rate (0.4 vs. 0.3 %), longer hospital stays (5.1 vs. 3.7 days), lower proportion discharged home routinely (61.0 vs. 76.8 %), and increased total hospital charges ($85,138 vs. $71,808), respectively. Conclusions The reported incidence of DT in spine surgery was 2.7 % in the US. Risk factors included older age, female gender, increased comorbidities, and high hospital caseload. DT increased the rate of in-hospital complications and mortality and health care burdens.

The effect of incidental dural lesions on outcome after decompression surgery for lumbar spinal stenosis: results of a multi-center study with 800 patients

“…This fact may be attributed mainly to differences in patient cohorts as well as the types of surgical procedures and indications. The majority of these previously published studies reported the overall incidence of dural lacerations across a variety of spinal surgeries [10,12,19,20], such as combined fusion and decompression procedures [7,9,11,21]. For lumbar disc surgery, the previously published incidences of dural tears seem to be relatively low, with reports ranging between 2 and 6 % [22,23].…”

“…This variation may be attributed to the fact that some studies include all types of lumbar spine surgeries, while other studies focus on decompression procedures exclusively. Risk factors for the occurrence of an incidental durotomy include epidural adhesions associated with previous surgeries, synovial cysts, severe spinal stenosis, increased comorbidities, smoking, and increased patient age [8][9][10][11][12]. Previously published studies investigated whether an incidental durotomy is associated with an inferior outcome after lumbar decompression surgery.…”

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

“…The Elixhauser measure has not been introduced in orthopaedic surgery research until recently [17,26,39,57,59,60], perhaps because of scarce reported comparisons with the Charlson model [17] and concerns regarding the inclusion of too many explanatory variables (31 variables), therefore requiring a relatively large sample size [27]. The main attractiveness of the use of large administrative databases for medical research lies in the possibility of studying rare occurrence events, such as inpatient mortality, that otherwise would be difficult to investigate in small population studies [14].…”

Clinical Profile of Patients With Severe Anaphylaxis Hospitalized in the Spanish Hospital System: 1997-2011

“…Arrhythmias are associated with a worse course of anaphylaxis owing to mechanisms other than those involved in congestive heart failure, since the distribution of both variables differed. The appearance of heart block and arrhythmias may be related to myocardial hypoxia during anaphylaxis [24,26] or local secretion of noradrenaline from sympathetic nerve endings resulting from secretion of renin from mast cells and activation of the renin-angiotensin system [21]. The evidence presented above suggests that arrhythmias follow the onset of anaphylaxis.…”

“…The presence of mast cells in the heart and the release of cardiotoxic mediators such as histamine, LTC4, and platelet-activating factor [21], as well as the increase in mast cell counts in the coronary vessels of patients with ischemic heart disease, can render the heart incapable of overcoming the systemic and cardiac effects of anaphylaxis. In addition, the widespread concomitant use of β-blockers and ACE inhibitors in cardiovascular diseases [22,23] has been considered to cause more severe anaphylaxis in patients with heart disease [24].…”