Epidemiologic investigation on neurological complications following neuraxial anesthesia in 2.7 million cases in Southwest China

Abstract

Neuraxial anesthesia provides effective anesthesia and analgesia for surgery, but may cause neurological complications. The rate of neurological complications in China remains unclear. This study conducted a retrospective epidemiological investigation of neurological complications following neuraxial anesthesia in Guangxi, southwest China. This survey used the "Golden Data" platform to distribute questionnaires to anesthesiology departments across hospitals of varying levels in Guangxi, gathering data on neuraxial anesthesia methods and associated neurological complications from 2013 to 2022. Detailed patient information was recorded, with missing data supplemented by phone. The Adverse Event Reporting System was also utilized to verify and supplement cases, supported by peer review. The study analyzed the incidence and clinical characteristics of neurological complications after neuraxial anesthesia. A comprehensive survey was conducted across 243 hospitals, encompassing 2,723,615 cases of neuraxial anesthesia. The survey identified 1208 cases of neurological complications, with an incidence of 0.44‰, primarily occurring in patients undergoing obstetrics, gynecology, orthopedics, urology, and general surgery. The complications included transient nerve syndrome (999 cases), spinal injury (188 cases), cauda equina syndrome (13 cases), spinal hematoma (5 cases), anterior spinal artery syndrome (2 cases), and conus medullaris injury (1 case). The incidence of neurological complications associated with combined spinal-epidural anesthesia (0.53‰) was significantly higher than that of epidural anesthesia (0.21‰) and spinal anesthesia (0.35‰) (P < 0.001). Among the patients, 97.3% achieved full recovery, while 2.7% (30 cases) suffered permanent neurological damage. Although neurological complications are relatively rare, comprehensive preoperative assessment, adherence to standardized protocols, and vigilance regarding potential complications are essential.

Keywords: Combined spinal-epidural anesthesia; Epidemiologic investigation; Epidural anesthesia; Neurological complications; Spinal anesthesia.