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Cerebrospinal fluid (CSF) leak after elective lumbar spinal fusion: Who is at risk?
European Spine Journal ( IF 2.8 ) Pub Date : 2022-09-12 , DOI: 10.1007/s00586-022-07383-9
Gabriel Hanna 1 , Alejandro Pando 1 , Stephen Saela 2 , Arash P Emami 2
Affiliation  

Purpose

CSF leaks are a known complication of lumbar fusion surgery. There is a scarcity of literature describing the incidence and risk factors associated with this complication. The aim of this study was to identify patients who are at risk of developing postoperative CSF leak.

Methods

The Nationwide Inpatient Sample database was used to identify patients who had lumbar fusion in the US from 2002 to 2014. Inpatient outcomes included the incidence and risk of developing CSF leak based on selected patient-specific characteristics. Secondary outcomes included average length of stay, mean costs, and mortality rates. All statistical analyses were conducted based on multivariate regression models using the SPSS software.

Results

A total of 439,220 patients who underwent elective lumbar fusion procedures were identified. Of these patients, 2.6% (11,636 /439,220) were found to have CSF leak. Independent important risk factors for CSF leak development included: older age (OR: 1.025; 95% CI: 1.02–1.03; p < 0.0001), posterior approach (OR: 1.71; 95% CI: 1.59–1.85; p < 0.0001) compared to anterior approach, chronic deficiency anemia (OR: 1.21; 95% CI:1.14–1.30; p < 0.0001), obesity (OR: 1.22; 95% CI: 1.15–1.30; p < 0.0001), and pulmonary circulatory disease (OR: 1.44; 95% CI: 1.18–1.75; p < 0.0001). CSF leak was associated with increased length of stay (5.39 ± 3.86 vs. 3.74 ± 2.55; p < 0.0001), hospitalization costs (120,129.0 ± 88,123.5 vs. 89,226.8 ± 65,350.3; p < 0.0001) and mortality (0.3% vs. 0.1%; p < 0.05).

Conclusion

Spine surgeons should be aware of certain patient and procedure-specific characteristics that increase the risk of developing postoperative CSF leak after lumbar fusion in order to improve patient outcomes.



中文翻译:

选择性腰椎融合术后脑脊液 (CSF) 渗漏:谁有风险?

目的

脑脊液漏是腰椎融合手术的已知并发症。描述与这种并发症相关的发病率和危险因素的文献很少。本研究的目的是确定有发生术后脑脊液漏风险的患者。

方法

全国住院患者样本数据库用于识别 2002 年至 2014 年在美国进行腰椎融合术的患者。住院患者结果包括根据选定的患者特定特征发生脑脊液漏的发生率和风险。次要结果包括平均住院时间、平均费用和死亡率。所有统计分析均使用 SPSS 软件基于多元回归模型进行。

结果

总共确定了 439,220 名接受了择期腰椎融合手术的患者。在这些患者中,2.6% (11,636 /439,220) 被发现有脑脊液漏。CSF 渗漏发生的独立重要危险因素包括:年龄较大(OR:1.025;95% CI:1.02–1.03;p  < 0.0001),后路手术(OR:1.71;95% CI:1.59–1.85;p  < 0.0001)比较前路、慢性缺乏性贫血(OR:1.21;95% CI:1.14–1.30;p  < 0.0001)、肥胖(OR:1.22;95% CI:1.15–1.30;p  < 0.0001)和肺循环疾病(OR :1.44;95% CI:1.18–1.75;p  < 0.0001)。CSF 渗漏与住院时间延长有关(5.39 ± 3.86 对 3.74 ± 2.55;p < 0.0001)、住院费用(120,129.0 ± 88,123.5 对比 89,226.8 ± 65,350.3;p  < 0.0001)和死亡率(0.3% 对比 0.1%;p  < 0.05)。

结论

脊柱外科医生应了解某些患者和手术的特定特征,这些特征会增加腰椎融合术后发生术后脑脊液漏的风险,以改善患者的预后。

更新日期:2022-09-12
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