• Sintaro Tsuge, Akihito Wada, Yasuaki Iida, Yasuhiro Inoue, Katsunori Fukutake, Yuji Nishiwaki, and Hiroshi Takahashi.
• Department of Orthopaedic Surgery, School of Medicine, Toho University, Tokyo, Japan.
• J Orthop Surg (Hong Kong). 2019 Sep 1; 27 (3): 2309499019885449.

Study DesignThe present study is a single-center retrospective cohort study.ObjectiveThe objective of the study is to verify the hypothesis that sharp elevation of systolic blood pressure at extubation is a risk factor for development of symptomatic epidural hematoma after spinal surgery.Summary Of Background DataPostoperative symptomatic epidural hematoma (she) after spine surgery is a rare but potentially serious complication that may result in paralysis unless removed at an early stage.MethodsThe subjects were 2611 patients treated with decompression and decompression/fusion of the cervical, thoracic, and lumbar vertebrae at our hospital. Twelve of these patients developed postoperative SEH and removal of hematoma was performed. To investigate the risk factors in these patients, data were analyzed for age at the time of surgery, sex, preoperative complications, medical history, body mass index, preoperative platelet count, surgical procedure, microscope use, operative time, blood loss, surgical site, systolic blood pressure (SBP) at extubation, difference between resting and extubation SBP, ratio of SBP at extubation to that at rest, blood pressure at discharge from the operating room, and use of a drain.ResultsThere was a significantly higher rate of SBP ratio (extubation/rest) ≥1.3 in patients with SEH (p = 0.021, Fisher's exact test). Among the preoperative complications and medical histories, the frequency of cerebrovascular disorder tended to be higher in SEH cases than in non-SEH cases (p = 0.073). There was no significant difference for all other parameters listed above. In multivariate logistic analysis, the odds ratios were 3.98 (p = 0.018) for an SBP ratio (extubation/rest) ≥1.3 and 4.75 (p = 0.055) for cerebrovascular disorder, suggesting effects of these two items. With simultaneous input into a multivariate model, SBP ratio ≥1.3 had a significant independent association with postoperative SEH (p = 0.021) and cerebrovascular disorder showed a tendency for this association (p = 0.072).ConclusionThe risk for symptomatic epidural hematoma is significant in patients with SBP at extubation that is more than 1.3 times that of SBP at rest.

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