Artikel
Placement of redon drainage solely depends on length of posterior cervical instrumentation without significant impact on complication rate
Die Anlage einer Redondrainage ist nur von der Länge dorsaler, zervikaler Instrumentation abhängig, ohne Einfluss auf die Komplikationsrate
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Autoren
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Christina Wolfert
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Björn Sommer
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Christian von der Brelie
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
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Ingo Fiss
- Universitätsmedizin Göttingen, Neurochirurgie, Göttingen, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Complication rates up to 19% had been reported after dorsal fusion for cervical instability. Postoperative pain and cardiopulmonary difficulties are wide-spread. Spinal epidural hematoma (SEH) and surgical site infections (SSI) are rarer, but are possibly leading to long-term sequela, are more dreaded with ranges up to 1.5% (SEH) and 4.7% (SSI). Redon drainage (RD) is frequently used to avoid these complications, without definitive guidelines. For this reason, this study aims to examine the relationship between placement of a RD and complication rate of SSI and SEH.
Methods: Monocentric, retrospective review of 319 consecutive patients who underwent first-time cervical fusion from 2012 to 2018. Demographic, clinical, operative and follow up characteristics were compared between patients with/without RD placement using uni- and multivariate regression models (UR, MR) to identify independent predictors of RD placement (Statistic Software R Version 3.4.0; R Core Team 2018; p < 0.05 was considered statistically significant).
Results: Of 319 patients (44.8% f), with mean age 66.4 years (22-98), 208 (65.2%) had a RD placed. Overall, fifteen patients (4.7%) developed SSI, which lead to revision surgery, while revision due to SEH was necessary in seven patients (2.2%). These events occurred independently of RD placement (p=1.0).Furthermore, total number of operated levels had no significant impact on the occurrence of complications (OR=1.3; p=0.07).
Stabilization of one or two segments was performed most frequently (one: n=125; 39.2%, two: n=102; 32.0%), while three (n=43; 13.5%) and four or more segments were treated less frequently (n=49; 15.4%).UR identified duration of surgery (OR=1.0; p=0.00001), total number of operated levels (OR=1.5; p=0.00016), and simultaneously performed decompression (OR=1.8; p=0.01) as independent predictors of RD placement. MR solely confirmed "total number of levels operated" (OR 1.1; p=0.009) as independent predictor, with significant increase with more than three operated levels (OR=1.7; p=0.001).
Conclusion: Placement of a RD solely depends on the length of posterior cervical instrumentation. Separate analysis of patients with and without placement of a RD did not reveal any differences in re-operation rate due to SSI and SEH. Regarding these results, a clear recommendation towards routine placement of a RD cannot be made.
