Factors predicting venous thromboembolism after spine surgery

Abstract

Background:A meta-analysis was performed to explore predicted factors of venous thromboembolism (VTE) after surgery in the treatment for spine degeneration diseases.Summary of background data:Many scholars have focused on VTE after spine surgery, but as for the risk factors of VTE have not reached a consensus.Methods:An extensive search of literature, “spine or spinal,” “degeneration,” “after surgery or postoperation,” and “venous thromboembolism” as key words, was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases. The following variables were extracted: wearing elastic stocking, hypertension (HT), heart disease, diabetes, drinking, anticoagulant therapy, walking disability preoperation, smoking, sex, age, surgical duration, fusion versus nonfusion (lumbar fusion vs lumbar discectomy), surgical site (cervical vs lumbar), blood loss, and body mass index. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:A total of 12 studies were identified, including 34,597 patients of whom 624 patients had VTE, and the incidence of VTE was 2% in all patients who underwent spine surgery. The incidence of VTE for Asian patients was 7.5%, compared with 1% VTE for Occidental patients; the difference was significant (P < 0.0001). The pooled analysis showed that there were significant differences regarding wearing elastic stocking (odds ratio [OR] = 11.71, 95% confidence interval [CI] [1.46, 94.00], P = 0.02), walking disability preoperation (OR = 4.80, 95% CI [2.53, 9.12], P < 0.00001), surgical site (lumbar surgery) (OR = 0.23, 95% CI [0.20, 0.27], P < 0.00001), HT (OR = 1.59, 95% CI [1.21, 2.10], P = 0.001), and diabetes (OR = 2.12, 95% CI [1.09, 4.10], P = 0.03). However, there were no significant differences in blood loss, heart disease, smoking, sex, surgical duration, body mass index, surgical duration, anticoagulant therapy, wearing elastic stocking, fusion versus nonfusion, drinking, and age (all P > 0.05).Conclusions:Based on our meta-analysis, Asian patients, patients with walking disability preoperation, patients wearing elastic stocking, patients having undergone lumbar surgery, patients with a history of HT, and patients experiencing diabetes have a higher incidence of VTE after spine surgery.

Prolonged operative duration is associated with complications: a systematic review and meta-analysis

“…74,75 However, other complications including renal failure and myocardial infarction do not have well-defined relationships with operative duration; results are inconsistent across studies and vary across surgical specialties. 76 Thus, it is possible that pooling of all complications across all surgical specialties diluted the effect estimates in our study.…”

Risk factors for venous thromboembolism following spinal surgery

“…The overall incidence of VTE was 0.35%, which was much lower than in a previous meta-analysis. [ 40 ] In addition, it was found that the incidence of VTE in Asian patients was significantly higher than that in occidental patients, which indicated that Asian patients were more likely to suffer from VTE after spine surgery; the reason for this remains to be investigated by further research. Our study indicated that elderly patients were more likely to develop VTE, which was in line with previous studies.…”

Severe Leg Pain Following Spinal Cord Stimulator Implantation – A Case Report

“…A meta‐analysis by Piper et al revealed 13 factors associated with VTE: nine preoperative factors (dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race); three operative factors (surgery duration >4 hours, emergency presentation, and American Society of Anesthesiologists Class III‐V); and one postoperative factor, sepsis . Another meta‐analysis describing VTE incidence showed higher incidence of VTE after spine surgery when wearing elastic stockings, undergoing lumbar surgery, having a history of hypertension and diabetes, being of Asian descent, or having ambulatory impairments prior to surgery . The commonalities between these two studies are the preoperative immobility status and hypertension as predictive factors.…”