Risk Factors and Management of Incidental Durotomy in Lumbar Interbody Fusion Surgery

Enders, Frederik; Ackemann, Amelie; Müller, Simon; Kiening, Karl; Orakcioglu, Berk

doi:10.1097/bsd.0000000000000572

Cited by 14 publications

(8 citation statements)

References 29 publications

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“…Consequences of durotomy include postoperative headache, meningitis, new-onset neurological deficit, pseudomeningocele, and need for surgical revision. 4 Durotomy can lead to worse short-term patient quality-of-life outcomes and higher levels of patient dissatisfaction. 6 Strömqvist and colleagues investigated postoperative quality-of-life outcomes in a cohort of 64,431 patients who underwent surgery for lumbar stenosis, spondylolisthesis, or disc herniation.…”

Section: Impact Of Durotomy On Patient Outcomes and Care Costsmentioning

confidence: 99%

“…As a second concern, the increased hospital LOS, postoperative antibiotic requirement, and risk of requiring revision surgery all increase direct care costs. 4 This both increases costs to the patient and healthcare system, consequently decreasing the cost-effectiveness of spine surgery. Using a cohort of more than 40,000 patients from the Medicare insurance database, Puvanesarajah and Hassanzadeh 5 found that expenditures for patients with incidental durotomies were more than $4000 higher per patient, a nearly 67% increase.…”

Section: Impact Of Durotomy On Patient Outcomes and Care Costsmentioning

confidence: 99%

“…2 Consequences of dural tears include postoperative headache, meningitis, new-onset neurological deficit, pseudomeningocele, need for surgical revision, and significant financial costs to the patient and health system. [3][4][5][6] Previous ABBREVIATIONS ASA = American Society of Anesthesiologists; ASD-S = adult spinal deformity-surgical; AUC = area under the curve; CCI = Charlson Comorbidity Index; LOS = length of stay; NLP = natural language processing; PRC = precision-recall curve; ROC = receiver operating characteristic.…”

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Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Ehresman

Pennington

Karhade

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEIncidental durotomy is a common complication of elective lumbar spine surgery seen in up to 11% of cases. Prior studies have suggested patient age and body habitus along with a history of prior surgery as being associated with an increased risk of dural tear. To date, no calculator has been developed for quantifying risk. Here, the authors’ aim was to identify independent predictors of incidental durotomy, present a novel predictive calculator, and externally validate a novel method to identify incidental durotomies using natural language processing (NLP).METHODSThe authors retrospectively reviewed all patients who underwent elective lumbar spine procedures at a tertiary academic hospital for degenerative pathologies between July 2016 and November 2018. Data were collected regarding surgical details, patient demographic information, and patient medical comorbidities. The primary outcome was incidental durotomy, which was identified both through manual extraction and the NLP algorithm. Multivariable logistic regression was used to identify independent predictors of incidental durotomy. Bootstrapping was then employed to estimate optimism in the model, which was corrected for; this model was converted to a calculator and deployed online.RESULTSOf the 1279 elective lumbar surgery patients included in this study, incidental durotomy occurred in 108 (8.4%). Risk factors for incidental durotomy on multivariable logistic regression were increased surgical duration, older age, revision versus index surgery, and case starts after 4 pm. This model had an area under curve (AUC) of 0.73 in predicting incidental durotomies. The previously established NLP method was used to identify cases of incidental durotomy, of which it demonstrated excellent discrimination (AUC 0.97).CONCLUSIONSUsing multivariable analysis, the authors found that increased surgical duration, older patient age, cases started after 4 pm, and a history of prior spine surgery are all independent positive predictors of incidental durotomy in patients undergoing elective lumbar surgery. Additionally, the authors put forth the first version of a clinical calculator for durotomy risk that could be used prospectively by spine surgeons when counseling patients about their surgical risk. Lastly, the authors presented an external validation of an NLP algorithm used to identify incidental durotomies through the review of free-text operative notes. The authors believe that these tools can aid clinicians and researchers in their efforts to prevent this costly complication in spine surgery.

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Section: Impact Of Durotomy On Patient Outcomes and Care Costsmentioning

confidence: 99%

Section: Impact Of Durotomy On Patient Outcomes and Care Costsmentioning

confidence: 99%

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confidence: 99%

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Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Ehresman

Pennington

Karhade

et al. 2020

Journal of Neurosurgery: Spine

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“…Patients having major orthopedic surgery (DVT) have an increased risk of venous thromboembolism, which may include pulmonary embolism (PE) and deep venous thrombosis [ 1 ]. VTE is a well-known and feared surgical complication, as well as a leading cause of death [ 2 ]. Acute thromboembolic illness (VTE) may result in substantial morbidity, poor quality of life, and even death [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Venous Thrombosis after Spinal Surgery: A Systematic Review and Meta-analysis

Wang

2022

Computational and Mathematical Methods in Medicine

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Background. Venous thrombosis, comprising DVT and PE, is an orthopedic condition that may be fatal after surgery. This study’s purpose was to analyze risk factors for venous thrombosis following spine surgery to help guide treatment prophylaxis. Methods. A computer searched English databases such as PubMed, Web of Science, Embase, Cochrane Library, and Google Academic for relevant publications after spinal surgery. Preoperative walking difficulties, hypertension, diabetes, heart disease, preoperative bleeding volume, etc., were all examined using the NOS scale. Data were analyzed using Review Manager 5.3 software. An analysis was done. Due to the study’s differences, the data was compiled using fixed effects or random effects models. Results. A total of 25 studies were considered, with a total of 1,927,781 individuals after spine surgery, including 7843 patients with venous thrombosis. The included literatures had NOS scores ranging from 5 to 8. According to the findings of the meta-analysis, the age of patients with venous thrombosis after spinal surgery ( OR = 7.53 , 95% CI (6.73, 8.33)), blood loss ( OR = − 141.79 , 95% CI (-154.68, -128.9), P = 0.00001 ), and operation time ( OR = 76.93 , 95% CI (73.17, 80.86), P = 0.00001 ) were higher than those without; diabetes mellitus (OR =1.23, 95% CI (1.12, 1.34), P = 0.00001 ) and walking disability history ( OR = 2.97 , 95% CL (1.77, 4.98), P = 0.0001 ) increased the incidence of postoperative venous thrombosis. Conclusion. High age, female, spinal fusion, big volume blood loss patients, operation time, and hypertension, diabetes, and walking issue are all risk factors for venous thrombosis following surgery.

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“…Incidental durotomy, a complication of spine surgery, occurs more frequently in the lumbar spine, especially during revision procedures. Its incidence ranges between 3% and 27% of all spinal operations, [1][2][3] with an apparent predilection for posterior access interventions. 4,5 Posterior spinal arthrodesis, a common procedure, is performed for various indications such as degenerative diseases, trauma, infections, and tumors.…”

Section: Introductionmentioning

confidence: 99%

Incidental Durotomy Following Transforaminal Lumbar Interbody Fusion Performed with the Modified Wiltse Approach

Sheinis

Benharroch

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Purpose Incidental durotomy is an intraoperative complication that occurs in 3 to 27% of lumbar spine surgeries. It has been reported more commonly following revision spinal procedures. Study Objectives To investigate the frequency of incidental durotomy while performing transforaminal lumbar interbody fusion (TLIF) using the modified Wiltse approach. A secondary goal was to compare the incidence of durotomy in patients undergoing primary spine surgery with those undergoing revision surgery. Methods A group of consecutive patients who had undergone (TLIF) in the last 10 years ending in 2015 were enrolled in the study. All patients underwent TLIF via the modified Wiltse approach that included a central midline skin incision, followed by a paravertebral blunt dissection of the paraspinal muscles to reach the transverse processes. The deep paravertebral dissection was done conservatively, one side at a time. Demographic and clinical data were collected when relevant to the comparison. Results The study cohort encompassed 257 patients: 200 primary cases and 57 revisions. The frequency of incidental durotomy was equal in both groups: 3.5% each (7/200 and 2/57). All durotomies were repaired primarily. No other immediate or late complications were observed during follow-up. Conclusion The present study displays a limited incidence of durotomy in the primary interventions and to a lesser degree in the revisions, all of which had used a TLIF performed with the modified Wiltse approach. This procedure probably circumvented the need for further revisions.

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Risk Factors and Management of Incidental Durotomy in Lumbar Interbody Fusion Surgery

Cited by 14 publications

References 29 publications

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Incidental durotomy: predictive risk model and external validation of natural language process identification algorithm

Risk Factors for Venous Thrombosis after Spinal Surgery: A Systematic Review and Meta-analysis

Incidental Durotomy Following Transforaminal Lumbar Interbody Fusion Performed with the Modified Wiltse Approach

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