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Estimating the Incidence of Suspected Epidural Hematoma and the Hidden Imaging Cost of Epidural Catheterization: A Retrospective Review of 43,200 Cases
  1. Jesse M. Ehrenfeld, MD, MPH*,,
  2. Anish K. Agarwal, MD, MPH,
  3. Justin P. Henneman, MS and
  4. Warren S. Sandberg, MD, PhD*
  1. *Departments of Anesthesiology, Surgery, and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN; †Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston; and ‡Department of Emergency Medicine, The Hospital at the University of Pennsylvania, Philadelphia.
  1. Address correspondence to: Jesse M. Ehrenfeld, MD, MPH, Department of Anesthesiology, Vanderbilt University, 1301 Medical Center Dr, Suite 4648 TVC, Nashville, TN 37232 (e-mail: jesse.ehrenfeld{at}


Background and Objectives Hematoma associated with epidural catheterization is rare, but the diagnosis might be suspected relatively frequently. We sought to estimate the incidence of suspected epidural hematoma after epidural catheterization and to determine the associated cost of excluding or diagnosing an epidural hematoma through radiologic imaging.

Methods We conducted an electronic retrospective chart review of 43,200 patient charts using 4 distinct search strategies and cost analysis, all from a single academic institution from 2001 through 2009. The charts were reviewed for use of radiologic imaging studies to identify patients with suspected and confirmed epidural hematomas. Costs for imaging to exclude or confirm the diagnosis were related to the entire cohort.

Results In our analysis, during a 9-year period that included 43,200 epidural catheterizations, 102 patients (1/430) underwent further imaging studies to exclude or confirm the presence of an epidural hematoma—revealing 6 confirmed cases and an overall incidence (per 10,000 epidural blocks) of epidural hematoma of 1.38 (95% confidence interval, 0–0.002). Among our patients, 207 imaging studies, primarily lumbar spine magnetic resonance imaging, were performed. Integrating Medicare cost expenditure data, the estimated additional cost during a 9-year period for imaging and hospital charges related to identifying epidural hematomas nets to approximately $232,000 or an additional $5.37 per epidural.

Conclusions Approximately 1 in 430 patients undergoing epidural catheterization will be suspected to have an epidural hematoma. The cost of excluding the diagnosis, when suspected, is relatively low when allocated across all patients undergoing epidural catheterization.

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  • Jesse M. Ehrenfeld, MD, MPH, and Anish K. Agarwal, MD, MPH, contributed equally to this study.

    The authors declare no conflict of interest.

    Financial support for the preparation of this article was provided by National Institutes of Health grant 5T32GM007592 and by department funds from the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.

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