Intracranial Hemorrhage Following Elective Spine Surgery: A 2021 National Inpatient Sample Analysis of Incidence and Risk Factors

Introduction: Although rare, intracranial hemorrhage (ICH) following durotomy during elective spine surgeries presents a serious risk to patient outcomes. These procedures carry the potential for dural tears (DT), which can result in postoperative cerebrospinal fluid leakage (PCSFL). Significant loss of cerebrospinal fluid may lead to a reduction in intracranial pressure, potentially causing ICH. There is limited literature documenting ICH as a postoperative complication in spine surgeries. This study aims to evaluate the incidence and associated risk factors for ICH in patients undergoing elective spinal procedures.

Methods: We analyzed data from the 2021 National Inpatient Sample (NIS), selecting adult patients (>18 years) who underwent spine fusion, discectomy, spinal cord decompression, and cervicothoracic or lumbosacral nerve decompression. Patients with trauma or malignancy were excluded from the study. The primary outcome measured was the occurrence of ICH. Comparative analyses and multivariable logistic regression were employed to identify independent risk factors.

Results: Out of 42,500 eligible patients, the incidence of ICH was identified in 0.09% of cases. Patients in the ICH group had significantly longer hospital stays and higher mortality rates than the control group. The occurrence of spinal cord decompression, DT, and PCSFL was notably more frequent in patients who developed ICH. Additionally, factors such as alcohol and drug abuse, along with hypertension, were significantly more prevalent in the ICH group. Independent risk factors for ICH included DT, alcohol abuse, and hypertension.

Conclusion : This analysis highlights the rarity yet severity of ICH following elective spine surgeries, stressing the need for heightened awareness and potential preventive strategies. The findings indicate that DT, along with patient-related factors like alcohol abuse and hypertension, are significant predictors of ICH, necessitating further attention to these risks during perioperative care.