Clin Orthop Surg.  2016 Dec;8(4):407-411. 10.4055/cios.2016.8.4.407.

Why Cannot Suction Drains Prevent Postoperative Spinal Epidural Hematoma?

• Ahn DK
• Shin WS
• Kim JW
• Yi SM

• KMID: 2412323
• DOI: http://doi.org/10.4055/cios.2016.8.4.407

Abstract

BACKGROUND
Postoperative spinal epidural hematoma (POSEH) is different from spontaneous or post-spinal procedure hematoma because of the application of suction drains. However, it appeared that suction drains were not effective for prevention of POSEH in previous studies. The purpose of this study was to test our hypothesis that POSEH can be caused by hypercoagulability.
METHODS
This was an experimental study. One hundred fifty milliliters of blood was donated from each of the 12 consecutive patients who underwent spine surgery and infused into 3 saline bags of 50 mL each. One of the 3 bags in each set contained 5,000 units of thrombin. All of them were connected to 120 ± 30 mmHg vacuum suctions: drainage was started 8 minutes after connection to the vacuum system for 12 normal blood bags (BV8) and 12 thrombin-containing blood bags (TBV8) and 15 minutes after connection for the remaining 12 normal blood bags (BV15). The amount of initial and remaining hematoma at 20 minutes, 120 minutes, and 24 hours after vacuum application were measured by their weight (g). The primary endpoint was the difference between BV8 and TBV8. The secondary end point was the difference between BV8 and BV15.
RESULTS
The remaining hematoma in TBV8 was significantly greater than that in BV8 at all measurement points: 46.3 ± 12.4 vs. 17.0 ± 1.3 (p = 0.000) at 20 minutes; 33.0 ± 8.2 vs. 16.3 ± 1.2 (p = 0.000) at 120 minutes; and 26.1 ± 4.0 vs. 15.8 ± 1.6 (p = 0.000) at 24 hours after vacuum application. The remaining hematoma of BV15 was significantly greater than that of BV8 at all measurement points: 30.0 ± 12.0 vs. 17.0 ± 1.3 (p = 0.002) at 20 minutes; 24.2 ± 7.6 vs. 16.3 ± 1.2 at 120 minutes (p = 0.002); and 22.2 ± 6.6 vs. 15.8 ± 1.6 (p = 0.004) at 24 hours after vacuum application.
CONCLUSIONS
With a suction drain in place, the amount of remaining hematoma could be affected by coagulability. Thrombin-containing local hemostatics and the length of time elapsed before the commencement of suction resulted in hypercoagulability, indicating these two factors could be causes of POSEH.

Keyword

Postoperative spinal epidural hematoma; Hypercoagulability; Suction drain

MeSH Terms

Aged
*Blood Physiological Phenomena
Drainage/*instrumentation/methods
Female
*Hematoma, Epidural, Spinal/physiopathology/prevention & control
Humans
Male
Middle Aged
*Models, Biological
*Postoperative Complications/physiopathology/prevention & control
Thrombin/physiology
Time Factors
Thrombin

Figure

• 

  Fig. 1 Photograph of the experimental setup. The blood filled bag was connected to a 120 ± 30 mmHg vacuum system through a 1.6-mm diameter drain tube and the weight was measured.

• 

  Fig. 2 Flowchart of the experiment. Blood obtained from a patient was divided into 3 bags. Two of them had normal blood and the other had thrombin (Th) added blood. Twelve normal and 12 Th added blood bags were connected to the vacuum and drainage was initiated 8 minutes after connection. The other 12 normal blood bags were connected to the vacuum and drainage was initiated 15 minutes after connection. The amount of remaining hematoma was measured at 20 minutes, 120 minutes, and 2 hours after initiation of drainage.

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