Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2023; 11(23): 5430-5439
Published online Aug 16, 2023. doi: 10.12998/wjcc.v11.i23.5430
Clinical characteristics and risk factors of intracranial hemorrhage after spinal surgery
Xin Yan, Li-Rong Yan, Zhi-Gang Ma, Ming Jiang, Yang Gao, Ying Pang, Wei-Wei Wang, Zhao-Hui Qin, Yang-Tong Han, Xiao-Fan You, Wei Ruan, Qian Wang
Xin Yan, Li-Rong Yan, Zhi-Gang Ma, Ming Jiang, Ying Pang, Wei-Wei Wang, Zhao-Hui Qin, Yang-Tong Han, Xiao-Fan You, Wei Ruan, Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
Yang Gao, Medical Record Management and Statistics, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
Qian Wang, Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, Beijing 100096, China
Author contributions: Yan X contributed to conceptualization, methodology, investigation, writing - original draft, supervision; Yan LR, Ma ZG, Jiang M, Pang Y, Wang WW, Qin ZH, Han YT, You XF, Ruan W, Wang Q contributed to investigation, data curation, writing - review & editing; Gao Y contributed to data retrieval.
Supported by “Xue Ke Xin Xing” of Beijing Jishuitan Hospital, Beijing, China, No. XKXX201611.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Beijing Jishuitan Hospital [Approval No. 202004-76].
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All study participants or their legal guardians provided informed written consent regarding personal and medical data collection before study enrolment.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at ynxn0403@163.com. Participants gave informed consent for data sharing.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin Yan, MD, Associate Chief Physician, Department of Neurology, Beijing Jishuitan Hospital, Capital Medical University, No. 68 Huinan Beilu, Changping District, Beijing 100096, China. ynxn0403@163.com
Received: May 24, 2023
Peer-review started: May 24, 2023
First decision: June 19, 2023
Revised: July 4, 2023
Accepted: July 18, 2023
Article in press: July 18, 2023
Published online: August 16, 2023
Processing time: 77 Days and 23.8 Hours
Abstract
BACKGROUND

Intracranial hemorrhage after spinal surgery is a rare and devastating complication.

AIM

To investigate the economic burden, clinical characteristics, risk factors, and mechanisms of intracranial hemorrhage after spinal surgery.

METHODS

A retrospective cohort study was conducted from January 1, 2015, to December 31, 2022. Patients aged ≥ 18 years, who had undergone spinal surgery were included. Intracranial hemorrhage patients were selected after spinal surgery during hospitalization. Based on the type of spinal surgery, patients with intracranial hemorrhage were randomly matched in a 1:5 ratio with control patients without intracranial hemorrhage. The patients' pre-, intra-, and post-operative data and clinical manifestations were recorded.

RESULTS

A total of 24472 patients underwent spinal surgery. Six patients (3 males and 3 females, average age 71.3 years) developed intracranial hemorrhage after posterior spinal fusion procedures, with an incidence of 0.025% (6/24472). The prevailing type of intracranial hemorrhage was cerebellar hemorrhage. Two patients had a poor clinical outcome. Based on the type of surgery, 30 control patients were randomly matched in 1:5 ratio. The intracranial hemorrhage group showed significant differences compared with the control group with regard to age (71.33 ± 7.45 years vs 58.39 ± 8.07 years, P = 0.001), previous history of cerebrovascular disease (50% vs 6.7%, P = 0.024), spinal dura mater injury (50% vs 3.3%, P = 0.010), hospital expenses (RMB 242119.1 ± 87610.0 vs RMB 96290.7 ± 32029.9, P = 0.009), and discharge activity daily living score (40.00 ± 25.88 vs 75.40 ± 18.29, P = 0.019).

CONCLUSION

The incidence of intracranial hemorrhage after spinal surgery was extremely low, with poor clinical outcomes. Patient age, previous stroke history, and dura mater damage were possible risk factors. It is suggested that spinal dura mater injury should be avoided during surgery in high-risk patients.

Keywords: Spinal surgery; Intracranial hemorrhage; Risk factors; Economic burden; Dura mater damage

Core Tip: The incidence of intracranial hemorrhage after spinal surgery was 0.025%. This resulted in high economic burden and poor clinical outcomes. Cerebellar hemorrhage was the most common imaging presentation. Age, previous stroke history, and dura mater damage were possible risk factors.