Predictors of Readmissions and Reoperations Related to Venous Thromboembolic Events After Spine Surgery: A Single-Institution Experience with 6869 Patients

Cloney, Michael; Dhillon, Ekamjeet S.; Roberts, Helena; Smith, Zachary A.; Koski, Tyler R.; Dahdaleh, Nader S.

doi:10.1016/j.wneu.2017.11.168

Cited by 16 publications

(16 citation statements)

References 36 publications

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“…Risk factors for VTE include age 27 , 28 , sex 29 , a history of immobility 29 - 31 , obesity 13 , smoking 32 , oral contraceptive use 33 , family history 29 , 30 , 34 , operative time 13 , volume of blood loss 35 , and comorbidities such as hypertension 29 , 36 and diabetes mellitus 13 . The independent predictors of DVT include a BMI of ≥40 kg/m 2 , an age of ≥80 years, an operative time of >261 minutes, and an American Society of Anesthesiologists (ASA) classification of ≥3, whereas the independent predictors of PE include a BMI of ≥40 kg/m 2 , an operative time of >261 minutes, and male sex 13 .…”

Section: Discussionmentioning

confidence: 99%

The Rate of Venous Thromboembolism Before and After Spine Surgery as Determined with Indirect Multidetector CT

Inoue

Watanabe

Okami³

et al. 2018

JBJS OA

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Background:This prospective cohort study investigated the rate of venous thromboembolism (VTE) before and after spine surgery as determined with use of indirect multidetector computed tomography (MDCT).Methods:We performed a prospective study of 105 patients (36 women and 69 men ranging in age from 38 to 88 years) undergoing spine surgery at 2 institutions. Indirect MDCT was performed before and 3 days after surgery. Patients with a history of dialysis or drug allergy to contrast medium were excluded.Results:No patient had symptomatic VTE preoperatively or postoperatively. The preoperative and postoperative rates of asymptomatic VTE were 4.8% and 13.0%, respectively; the rates of asymptomatic pulmonary embolism were 2.9% and 8.0%, respectively; and the rates of asymptomatic deep venous thrombosis were 3.8% and 6.0%, respectively. Age, sex, height, weight, body mass index, operative time, volume of intraoperative blood loss, and specific comorbidities (diabetes, hypertension, cardiac disease, previous VTE, and previous anticoagulation treatment) were not found to be risk factors.Conclusions:Our findings demonstrated a low rate of preoperative VTE but a high rate of postoperative VTE in association with spine surgery. Surgeons need to be aware of the risk of VTE in patients undergoing spine surgery. MDCT is an effective and convenient technology for the early detection of VTE in such patients.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

The Rate of Venous Thromboembolism Before and After Spine Surgery as Determined with Indirect Multidetector CT

Inoue

Watanabe

Okami³

et al. 2018

JBJS OA

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“…In patients with isolated orthopedic trauma, the transfusion of packed red blood cell is the risk factor for venous thromboembolism (VTE) [11]. Transfusion has also been reported to increase the risk of DVT in patients undergoing spine surgeries [12–15].…”

Section: Introductionmentioning

confidence: 99%

Perioperative allogenic blood transfusion increases the incidence of postoperative deep vein thrombosis in total knee and hip arthroplasty

et al. 2019

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Background Excessive blood loss caused by total joint arthroplasty (TJA) often increases the requirement for blood transfusion, which is associated with adverse outcomes. The purpose of this study was to determine the relationship between perioperative transfusion and postoperative DVT in TJA. Methods This retrospective study reviewed medical records of 715 patients, who consecutively underwent primary unilateral total knee arthroplasty (TKA) or total hip arthroplasty (THA) at our institution between September 2015 and March 2017. Demographic, clinical and surgical parameters were introduced into the univariate analysis to find risk factors for DVT within postoperative 30 days. In order to identify if allogenic blood transfusion was independently associated with DVT, a multivariate logistic regression analysis was conducted to adjust for gender, age, body mass index (BMI), diagnosis, and type of surgery. Results The incidence of perioperative allogenic blood transfusion was 12.4% ( n = 89). Fifty-seven patients (8.0%) developed DVT after surgery. Univariate analysis demonstrated that there were differences between DVT group and non-DVT group in gender ( P = 0.045), age ( P < 0.001), BMI ( P = 0.026), primary diagnosis ( P = 0.001), type of surgery ( P < 0.001), and transfusion rates ( P = 0.040). After adjustment by using multivariate logistic regression analysis, transfusion appeared to be the independent risk factor for DVT in TJA ( P = 0.001; OR = 3.9, 95%CI 1.8–8.4). Conclusion We found that perioperative allogenic blood transfusion was significantly associated with DVT following TJA. In order to reduce the risk of DVT and other adverse outcomes, methods to decrease transfusion rates should be used in clinical practice.

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“…26,42 The need for blood transfusions to compensate for these losses is associated with perioperative complications such as infections, thromboembolic events, and hemolytic transfusion reactions. 8,12,13,19,20,33,34,39,41,46 Also, patients requiring blood transfusion have been shown to have prolonged hospitalization, increased readmission and reoperation rates, and higher surgery-related costs. 12,22,29,34 Because of these various complications, there have been significant efforts to reduce the need for perioperative blood product transfusions.…”

Section: Discussionmentioning

confidence: 99%

Rotational thromboelastometry–guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study

Buell¹,

Taylor²,

Chen³

et al. 2019

Neurosurgical Focus

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OBJECTIVESignificant blood loss and coagulopathy are often encountered during adult spinal deformity (ASD) surgery, and the optimal intraoperative transfusion algorithm is debatable. Rotational thromboelastometry (ROTEM), a functional viscoelastometric method for real-time hemostasis testing, may allow early identification of coagulopathy and improve transfusion practices. The objective of this study was to investigate the effect of ROTEM-guided blood product management on perioperative blood loss and transfusion requirements in ASD patients undergoing correction with pedicle subtraction osteotomy (PSO).METHODSThe authors retrospectively reviewed patients with ASD who underwent single-level lumbar PSO at the University of Virginia Health System. All patients who received ROTEM-guided blood product transfusion between 2015 and 2017 were matched in a 1:1 ratio to a historical cohort treated using conventional laboratory testing (control group). Co-primary outcomes were intraoperative estimated blood loss (EBL) and total blood product transfusion volume. Secondary outcomes were perioperative transfusion requirements and postoperative subfascial drain output.RESULTSThe matched groups (ROTEM and control) comprised 17 patients each. Comparison of matched group baseline characteristics demonstrated differences in female sex and total intraoperative dose of intravenous tranexamic acid (TXA). Although EBL was comparable between ROTEM versus control (3200.00 ± 2106.24 ml vs 3874.12 ± 2224.22 ml, p = 0.36), there was a small to medium effect size (Cohen’s d = 0.31) on EBL reduction with ROTEM. The ROTEM group had less total blood product transfusion volume (1624.18 ± 1774.79 ml vs 2810.88 ± 1847.46 ml, p = 0.02), and the effect size was medium to large (Cohen’s d = 0.66). This difference was no longer significant after adjusting for TXA (β = −0.18, 95% confidence interval [CI] −1995.78 to 671.64, p = 0.32). More cryoprecipitate and less fresh frozen plasma (FFP) were transfused in the ROTEM group patients (cryoprecipitate units: 1.24 ± 1.20 vs 0.53 ± 1.01, p = 0.03; FFP volume: 119.76 ± 230.82 ml vs 673.06 ± 627.08 ml, p < 0.01), and this remained significant after adjusting for TXA (cryoprecipitate units: β = 0.39, 95% CI 0.05 to 1.73, p = 0.04; FFP volume: β = −0.41, 95% CI −772.55 to −76.30, p = 0.02). Drain output was lower in the ROTEM group and remained significant after adjusting for TXA.CONCLUSIONSFor ASD patients treated using lumbar PSO, more cryoprecipitate and less FFP were transfused in the ROTEM group compared to the control group. These preliminary findings suggest ROTEM-guided therapy may allow early identification of hypofibrinogenemia, and aggressive management of this may reduce blood loss and total blood product transfusion volume. Additional prospective studies of larger cohorts are warranted to identify the appropriate subset of ASD patients who may benefit from intraoperative ROTEM analysis.

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Predictors of Readmissions and Reoperations Related to Venous Thromboembolic Events After Spine Surgery: A Single-Institution Experience with 6869 Patients

Cited by 16 publications

References 36 publications

The Rate of Venous Thromboembolism Before and After Spine Surgery as Determined with Indirect Multidetector CT

The Rate of Venous Thromboembolism Before and After Spine Surgery as Determined with Indirect Multidetector CT

Perioperative allogenic blood transfusion increases the incidence of postoperative deep vein thrombosis in total knee and hip arthroplasty

Rotational thromboelastometry–guided transfusion during lumbar pedicle subtraction osteotomy for adult spinal deformity: preliminary findings from a matched cohort study

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