PT  - JOURNAL ARTICLE
AU  - PFLUGMACHER, ROBERT
AU  - FRANZINI, ANGELO
AU  - HOROVITZ, SHAKED
AU  - GUYER, RICHARD
AU  - ASHKENAZI, ELY
TI  - Suitability of Administrative Databases for Durotomy Incidence Assessment: Comparison to the Incidence Associated With Bone-Removal Devices, Calculated Using a Systemic Literature Review and Clinical Data
AID  - 10.14444/5061
DP  - 2018 Aug 01
TA  - International Journal of Spine Surgery
PG  - 498--509
VI  - 12
IP  - 4
4099  - https://www.ijssurgery.com/content/12/4/498.short
4100  - https://www.ijssurgery.com/content/12/4/498.full
SO  - Int J Spine Surg2018 Aug 01; 12
AB  - Background: Durotomy is a major complication of spinal surgery, potentially leading to additional clinical complications, longer hospitalization, and increased costs. A reference durotomy incidence rate is useful for the evaluation of the safety of different surgical aspects. However, the literature offers a wide range of incidence rates, complicating this comparison. Theoretically, a reference incidence value can be extracted from administrative databases, containing a large number of procedures. However, it is suspected that these databases suffer from underreporting of complications. This study aims to evaluate durotomy incidence using several large-scale databases and to assess the ability to use it as a reference by comparison to durotomy incidences directly associated with 4 bone removal devices, including the commonly used high-speed drill.Methods: Durotomy overall incidence was estimated from several administrative databases using different methods in order to achieve minimal and maximal estimations. Durotomy incidences for 3 bone removal devices were derived using literature meta-analysis, and the incidence for the fourth device was calculated using clinical data.Results: The incidence range of durotomy according to the databases was 2.8–3.5%. The calculated incidence of durotomy for the studied devices was 0.4–2.91%. The highest rate, 2.91%, is associated with the commonly used high-speed drill combined with Kerrison Rongeur and bone punches. Since bone-removal devices are just one of the possible causes of dural tears, the general incidence is expected to be higher than the incidence associated with the devices, yet even the maximal estimation, 3.5%, was only slightly higher, suggesting that the speculation of underreporting of dural tears to these databases is probably true, as also supported by the mostly higher incidences reported in the literature.Conclusions: Hospital administrative databases seem to show a lower-than-reasonable incidence of durotomy, suggesting possible underreporting. Researchers should therefore use this tool with caution. Reduction of the absolute durotomy incidence by approximately 2.5% can be achieved by improving the safety of bone-removal devices.