Risk factors associated with venous thromboembolism in patients undergoing spine surgery

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006–2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration &gt; 4 hours, emergency presentation, and American Society of Anesthesiologists Class III–V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of ≥ 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726–0.787).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.</jats:p></jats:sec>

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

“…78,[82][83][84][85] In contrast, the increased risk of VTE due to prolonged operative duration has been linked to factors such as increased coagulation, blood stasis, and endothelial damage resulting from longer surgical procedures. [86][87][88][89] Prolonged operative times are also associated with increased surgical team fatigue and extension of anesthesia durationdfactors that enhance the risk for many different types of complications. [90][91][92] However, it is also plausible that complications can, in reverse, prolong the duration of surgical procedures and hence contribute to the positive association between operative duration and complication risk.…”

Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery

“…In recent years, several studies have endeavored to use national databases to characterize incidence and risk factors for VTE in large, nationally representative samples [13][14][15][16]. The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is a national database consisting of more than 600 hospitals that catalog demographic, comorbidity, intraoperative, and postoperative factors up to Postoperative Day 30 for various surgical procedures [17].…”

“…Past investigations have characterized risk factors for VTE in the NSQIP sample [15,16]. However, by including patients with high-risk profiles (eg, trauma and emergency cases), these studies may not accurately describe patients undergoing elective surgery who may have a different risk profile.…”

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 .…”