High Risk of Symptomatic Venous Thromboembolism After Surgery for Spine Metastatic Bone Lesions: A Retrospective Study

Abstract

Background Cancer and spinal surgery are both considered risk factors for venous thromboembolism (VTE). However, the risk of symptomatic VTE for patients undergoing surgery for spine metastases remains undefined. Questions/purposes The purposes of this study were to: (1) identify the proportion of patients who develop symptomatic VTE within 90-days of surgical treatment for spine metastases; (2) identify the factors associated with the development of symptomatic VTE among patients receiving surgery for spine metastases; (3) assess the association between the development of postoperative symptomatic VTE and 1-year survival among patients who underwent surgery for spine metastases; and (4) assess if chemoprophylaxis increases the risk of wound complications among patients who underwent surgery for spine metastases. Methods Between 2002 and 2014, 637 patients at two hospitals underwent spine surgery for metastases. We considered eligible for analysis adult patients whose procedures were to treat cervical, thoracic, or lumbar metastases (including lymphoma and multiple myeloma). At followup after 90 days and 1 year, respectively, 21 of 637 patients (3%) and 41 of 637 patients (6%) were lost to followup. In general, we used 40 mg of enoxaparin or 5000 IUs subcutaneous heparin every 12 hours. Patients on preoperative chemoprophylaxis continued their initial medication postoperatively. All chemoprophylaxis was started 48 hours after surgery and continued day to day but was discontinued if a bleeding complication developed. Low-molecular-weight heparin (including enoxaparin and dalteparin, in general dosages of respectively 40 mg and 5000 IUs daily) was the most commonly used chemoprophylaxis in 308 patients (48%). Subcutaneous heparin was injected into 127 patients (20%); aspirin was used for 92 patients (14%); and warfarin was administered in 21 Each author certifies that neither he, nor any member of his immediate family, have funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his institution approved the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

Nomogram for Predicting the Postoperative Venous Thromboembolism in Spinal Metastasis Tumor: A Multicenter Retrospective Study

“…Therefore, it is reasonable to believe that this patient population has a higher prevalence of VTE. A recent retrospective study showed that 11% of patients with spinal metastases undergoing spinal surgery were observed to have symptomatic VTE ( 5 ). Accurately identifying risk factors related to VTE can help clinicians and patients determine which high-risk groups can be treated with interventions as soon as possible, which is very helpful for reducing perioperative mortality and improving postoperative survival time and quality of life.…”

“…For the risk factors of VTE after spinal surgery, some studies have reported the corresponding results, and some risk scores have been established ( 6 – 8 ). However, it is still unclear whether these conclusions are equally applicable to spinal metastasis surgery, because the treatment measures and prognostic characteristics of patients with spinal metastases are very specific ( 5 ). Therefore, it is very necessary to identify the risk factors of VTE in patients with spinal metastases.…”

Natural language processing for automated quantification of bone metastases reported in free-text bone scintigraphy reports

“…For example, creating a cohort of patients' multiple bone metastases can propel research in understanding the impact of skeletal related events in this complicated patient population. In addition, the clinical feature 'single versus multiple bone metastases' can be used in various studies as a risk factor for an outcome, as was the case for the studies that supplied the bone-scintigraphy reports [13,14]. This could substantially reduce reviewer burden and error rate.…”

“…EHRs of patients in our institutional database of metastatic bone tumor were reviewed [13,14]. We identified 1780 potentially eligible patients after screening the medical records, of which 1076 patients did not have a preoperative bone scintigraphy within 6 months.…”

CORR Insights®: High Risk of Symptomatic Venous Thromboembolism After Surgery for Spine Metastatic Bone Lesions: A Retrospective Study

“…Venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is one of the most-common and concerning complications these patients experience. Many thromboprophylaxis regimens are used in an attempt to minimize VTE, as seen by the highly varied regimens used in the current study by Groot and colleagues [3]. Despite aggressive perioperative thromboprophylaxis, the risk for postoperative VTE is prolonged well past the perioperative hospital stay [10].…”