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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Incidence of Postpartum Subdural Hematoma and its Association with Post-Dural Puncture Headache: A Review of the National Readmission Database for the years 2010 to 2014.

Abstract Number: BP-5
Abstract Type: Original Research

Albert Moore MD1 ; Paul Wieczorek MD2; Jose CA Carvalho MD,PhD3

Introduction: Subdural hematoma (SDH) has been linked to intracranial hypotension (1) and case reports have described its occurrence after dural puncture (2). The incidence of SDH and its association with dural puncture in the obstetric population is unknown.

Methods: We obtained data from the National Readmission Database (NRD) for the years 2010 to 2014. Women admitted for birth were identified using ICD 9 codes (3) and re-admissions linked to these women were used to construct a cohort. ICD codes and Clinical Classification Codes were used to identify patient conditions. The primary outcome was the presence of SDH and the primary exposure was the presence of postdural puncture headache (PDPH), identified within a 2 month postpartum period. Univariate comparisons were performed with Pearson’s chi squared tests, logistic regression or t-tests. A causal multivariate logistic model was developed with all considered confounders entered in one step.

Results: We included 18,872,555 women with 20,421,709 admissions and 18,893,605 deliveries. There were an estimated 493 births complicated by SDH, providing a national incidence of 2.6 (2.2-3.1) per 100,000 deliveries. Of these, 313 were diagnosed in a readmission occurring a mean of 12 (9-14) days after discharge for birth. Women with SDH required a mean of 10 (8-12) more hospitalization days and US$ 116,845 (88,300-145,390) more in hospital charges in the 2 month postpartum period. In this cohort, 0.21% of women received a blood patch, and less than 0.01% had a blood patch on a readmission after diagnosis of PDPH. Comparing non SDH to SDH groups, 0.01% versus 4% (p<0.001) died, and 0.003% versus 25 % (p<0.001) required neurosurgical procedures. Associations of SDH with clinical variables are presented in Table 1. After adjusting for these variables, the association of PDPH with SDH remained significant with an estimated odd ratio of 63.13 (39.08-101.99), resulting in a population attributable percent of 24.8% (17.3-31.5) and risk of 0.6 (0.4-0.9) per 100,000 deliveries.

Discussion: SDH is rare in the postpartum period, may occur weeks after discharge from birth hospitalisation, and is strongly associated with PDPH. After adjusting for confounders, it appears that 25% of SDH cases could be attributed to PDPH. Connective tissue disease, coagulopathy, and hypertension are associated with SDH. It appears that delaying a blood patch to an admission after diagnosis of PDPH is strongly associated with SDH. The NRD is an ideal database for the study of this outcome, but does present several limitations

References: 1) PLoS One 2015; 10: e0123616; 2) Anesthesiology 2000; 93: 1354-5; 3)Anesth Analg 2009; 109: 1174-81

SOAP 2018