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Desviat Ruiz M, Jordà Gómez P, Ramón López K, Romero Martínez JM, Valls Vilalta JJ, Fernández Fernández N, Chulvi Gimeno Á, Cuñat Navarro L, Poyatos Campos J. [Translated article] Thrombotic event prevention in patients undergoing posterior lumbar arthrodesis: Our experience. A retrospective case series study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:T55-T60. [PMID: 39522598 DOI: 10.1016/j.recot.2024.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 11/16/2024] Open
Abstract
INTRODUCTION There is no generalised consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural haematoma can be expected. MATERIALS AND METHODS A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography. RESULTS From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis. CONCLUSIONS By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.
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Affiliation(s)
- M Desviat Ruiz
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain.
| | - P Jordà Gómez
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - K Ramón López
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - J M Romero Martínez
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - J J Valls Vilalta
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - N Fernández Fernández
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - Á Chulvi Gimeno
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - L Cuñat Navarro
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
| | - J Poyatos Campos
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón, Spain
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Desviat Ruiz M, Jordà Gómez P, Ramón López K, Romero Martínez JM, Valls Vilalta JJ, Fernández Fernández N, Chulvi Gimeno Á, Cuñat Navarro L, Poyatos Campos J. Thrombotic Event Prevention in Patients Undergoing Posterior Lumbar Arthrodesis: our experiencie. A retrospective case series study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2025; 69:55-60. [PMID: 38825089 DOI: 10.1016/j.recot.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/04/2024] Open
Abstract
INTRODUCTION There is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE), either on using or timing it in patients undergoing spine surgery. VTE is a current concern because, even though being an uncommon event, it can cause serious complications. The aim of the present study is to propose guidelines for the prevention of thrombotic events in posterior spinal surgery, either as deep vein thrombosis or pulmonary thromboembolism. If the number of patients getting prophylaxis drugs is reduced a subsequent reduction of the incidence of epidural hematoma can be expected. MATERIALS AND METHODS A number of 235 patients who had undergone posterior spinal arthrodesis in the previous five years were studied. Mechanical thromboprophylaxis measures consisting of compression stockings were applied in all of them. Anticoagulant drugs were also applied whenever risk factors for thrombosis were observed. Early weight-bearing was resumed immediately after surgery. Demographic, clinical, and surgical variables were collected, as well as complications appearing during the follow-up period, that was scheduled at one, two, four, six and twelve months after the surgery. Thrombotic events, if present, were diagnosed by clinical and imaging tests such as ultrasound and CT angiography. RESULTS From the total 235 patients of this series, one hundred and fifty-three cases met the study inclusion criteria. A total of four thrombotic events appeared, one in the form of deep vein thrombosis and other three in the form of pulmonary thromboembolism. These last patients suffering an embolism died because of it. None of the variables studied had statistical significance for the occurrence of a thrombotic event. All four patients who suffered thrombotic events were receiving anticoagulant drugs, in addition to mechanical compression stockings, because of the presence of risk factors for thrombosis. CONCLUSIONS By applying the fore mentioned protocol, adequate prevention of thromboembolic events was achieved in this study population of patients undergoing posterior spinal surgery.
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Affiliation(s)
- M Desviat Ruiz
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón.
| | - P Jordà Gómez
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
| | - K Ramón López
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
| | - J M Romero Martínez
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
| | - J J Valls Vilalta
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
| | | | - Á Chulvi Gimeno
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
| | - L Cuñat Navarro
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
| | - J Poyatos Campos
- Cirugía Ortopédica y Traumatología, Hospital General Universitario de Castellón
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He M, Ye J, Zheng W, Qiao P, Gu H, Qin W, He X. The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study. Medicine (Baltimore) 2024; 103:e38423. [PMID: 38875425 PMCID: PMC11175867 DOI: 10.1097/md.0000000000038423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/29/2024] [Accepted: 05/10/2024] [Indexed: 06/16/2024] Open
Abstract
The aim of this study is to describe the general information, disease and treatment of venous thromboembolism (VTE) in critically ill patients, to explore the characteristics of severe patients with deep venous VTE and provide clinical reference data for the prevention and treatment of VTE in critically ill patients. This study carried out a retrospective study on the medical records of patients who were treated in the intensive care unit of Affiliated Hospital of Jining Medical College from 2020 to 2022. The general data, general conditions, drug use, past history, VTE prevention measures, post-VTE conditions, and Padua risk score of 297 patients with VTE during the period of hospitalization in intensive care unit (ICU) were classified and statistically analyzed. A total of 297 including 171 male and 126 male patient medical records were included in the analysis, we compared multiple clinical indicators between male and female patients. Compared to women, male patients have a higher acute physiology and chronic health evaluation II score(APACHE-II score) (P = .027), a higher state of consciousness (P = .003), a higher rate of smoking and drinking history (P < .001), a lower rate of heart failure (P = .003) and chronic depression (P = .013), and a higher rate of recommended operations for male patients after VTE (P = .031). The prothrombin time (PT) (P = .041) and activated partial thromboplastin time (APTT) (P = .040) of male patients were significantly higher than those of female patients, while triglyceride (P = .009) and total cholesterol (TC) (P = .001) were significantly lower than those of female patients. The difference in D-dimer (P = .739) was not significant. This study shows that male and female patients with VTE in the ICU have significant differences in general characteristics, general clinical conditions, history of past illness, thrombosis character, and examination items, this may be the reason for the different rates of VTE between male and female patients in the ICU.
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Affiliation(s)
- Meng He
- Department of Prehospital Emergency, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Jiuhang Ye
- Department of Critical Care Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Weiwei Zheng
- Department of Critical Care Medicine, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Peng Qiao
- Department of Emergency Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Haiyan Gu
- Emergency Internal Medicine Ward, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Wenwen Qin
- Emergency Internal Medicine Ward, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
| | - Xuehong He
- Department of Nursing, Affiliated Hospital of Jining Medical University, Jining, Shandong, P. R. China
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Kong WQ, Shao C, Du YK, Li JY, Shao JL, Hu HQ, Qu Y, Xi YM. Nomogram for predicting venous thromboembolism after spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1098-1108. [PMID: 38153529 DOI: 10.1007/s00586-023-08043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 10/16/2023] [Accepted: 11/04/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE This study aimed to establish a nomogram to predict the risk of venous thromboembolism (VTE), identifying potential risk factors, and providing theoretical basis for prevention of VTE after spinal surgery. METHODS A retrospective analysis was conducted on 2754 patients who underwent spinal surgery. The general characteristics of the training group were initially screened using univariate logistic analysis, and the LASSO method was used for optimal prediction. Subsequently, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative VTE in the training group, and a nomogram for predict risk of VTE was established. The discrimination, calibration, and clinical usefulness of the nomogram were separately evaluated using the C-index, receiver operating characteristic curve, calibration plot and clinical decision curve, and was validated using data from the validation group finally. RESULTS Multivariate logistic regression analysis identified 10 independent risk factors for VTE after spinal surgery. A nomogram was established based on these independent risk factors. The C-index for the training and validation groups indicating high accuracy and stability of the model. The area under the receiver operating characteristic curve indicating excellent discrimination ability; the calibration curves showed outstanding calibration for both the training and validation groups. Decision curve analysis showed the clinical net benefit of using the nomogram could be maximized in the probability threshold range of 0.01-1. CONCLUSION Patients undergoing spinal surgery with elevated D-dimer levels, prolonger surgical, and cervical surgery have higher risk of VTE. The nomogram can provide a theoretical basis for clinicians to prevent VTE.
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Affiliation(s)
- Wei-Qing Kong
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China
| | - Cheng Shao
- Department of Emergency, Shengli Oilfield Central Hospital, No. 31 Ji'nan Road, Dongying, 257000, Shandong Province, China
| | - Yu-Kun Du
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China
| | - Jian-Yi Li
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China.
| | - Jia-le Shao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China
| | - Hui-Qiang Hu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China
| | - Yang Qu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China
| | - Yong-Ming Xi
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, No. 59 Haier Road, Qingdao, 266000, Shandong Province, China.
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Jiao Y, Mu X. Coagulation parameters correlate to venous thromboembolism occurrence during the perioperative period in patients with spinal fractures. J Orthop Surg Res 2023; 18:928. [PMID: 38057818 DOI: 10.1186/s13018-023-04407-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is one of the leading causes of mortality in hospitalized patients. However, whether the coagulation-related parameters of the hospitalized patients could be used to predict the occurrence of VTE in patients with spinal injury surgery remained unclear. METHOD The patients with spinal fractures who met the inclusion and exclusion criteria were enrolled to be analyzed using a retrospective analysis approach. The association of risk factors of enrolled patients and operations to VTE occurrence were analyzed. The activated partial thromboplastin time, prothrombin time, thrombin time, D-dimer (D-D), fibrinogen (FIB) and fibrinogen degradation products (FDP) were detected. ROC and HR analysis were applied to evaluate the correlation of coagulation-related parameters and other parameters to VTE occurrence. RESULT The indicators of D-D, FIB and FDP were significantly elevated in VTE patients compared to non-VTE patients. The multivariate analysis of OR showed that six risk factors, including age ≥ 60, spinal cord injury, postoperative bedtime over 5 days, plasma D-dimer ≥ 0.54 mg/L, plasma fibrinogen ≥ 3.75 g/L and plasma FDP ≥ 5.19 mg/L, were positively correlated to VTE. CONCLUSION The six risk factors, including D-D, FIB, FDP, age ≥ 60, spinal cord injury, and postoperative bedtime over 5 days, could be used to predict the occurrence of VTE.
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Affiliation(s)
- Yong Jiao
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, No. 5 Haihai Warehouse, Dongzhimen, Beijing, 100000, China
| | - Xiaohong Mu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, No. 5 Haihai Warehouse, Dongzhimen, Beijing, 100000, China.
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Katiyar P, Chase H, Lenke LG, Weidenbaum M, Sardar ZM. Using Machine Learning (ML) Models to Predict Risk of Venous Thromboembolism (VTE) Following Spine Surgery. Clin Spine Surg 2023; 36:E453-E456. [PMID: 37482644 PMCID: PMC10805960 DOI: 10.1097/bsd.0000000000001498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVES Venous thromboembolism (VTE) is a potentially high-risk complication for patients undergoing spine surgery. Although guidelines for assessing VTE risk in this population have been established, development of new techniques that target different aspects of the medical history may prove to be of further utility. The goal of this study was to develop a predictive machine learning (ML) model to identify nontraditional risk factors for predicting VTE in spine surgery patients. SUMMARY OF BACKGROUND DATA A cohort of 63 patients was identified who had undergone spine surgery at a single center from 2015 to 2021. Thirty-one patients had a confirmed VTE, while 32 had no VTE. A total of 113 attributes were defined and collected via chart review. Attribute categories included demographics, medications, labs, past medical history, operative history, and VTE diagnosis. METHODS The Waikato Environment for Knowledge Analysis (WEKA) software was used in creating and evaluating the ML models. Six classifier models were tested with 10-fold cross-validation and statistically evaluated using t tests. RESULTS Comparing the predictive ML models to the control model (ZeroR), all predictive models were significantly better than the control model at predicting VTE risk, based on the 113 attributes ( P <0.001). The Random Forest model had the highest accuracy of 88.89% with a positive predictive value of 93.75%. The Simple Logistic algorithm had an accuracy of 84.13% and defined risk attributes to include calcium and phosphate laboratory values, history of cardiac comorbidity, history of previous VTE, anesthesia time, selective serotonin reuptake inhibitor use, antibiotic use, and antihistamine use. The J48 model had an accuracy of 80.95% and it defined hemoglobin laboratory values, anesthesia time, beta-blocker use, dopamine agonist use, history of cancer, and Medicare use as potential VTE risk factors. CONCLUSION Further development of these tools may provide high diagnostic value and may guide chemoprophylaxis treatment in this setting of high-risk patients.
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Affiliation(s)
- Prerana Katiyar
- Columbia University Vagelos College of Physicians and Surgeons
| | | | - Lawrence G. Lenke
- Columbia University Irving Medical Center
- Och Spine Hospital at New York Presbyterian
| | - Mark Weidenbaum
- Columbia University Irving Medical Center
- Och Spine Hospital at New York Presbyterian
| | - Zeeshan M. Sardar
- Columbia University Irving Medical Center
- Och Spine Hospital at New York Presbyterian
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Brennan J, Keblish D, Friedmann E, Spirt A, Holt E, Turcotte J. Postoperative venous thromboembolism risk-prediction in foot and ankle fracture surgery. Foot (Edinb) 2023; 56:102017. [PMID: 36966559 DOI: 10.1016/j.foot.2023.102017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) are rare but serious complications after foot and ankle fracture surgery. A consensus definition of a high-risk patient has not been reached, leading to significant variability in the use of pharmacologic agents for VTE prophylaxis. The aim of this study was to develop a model for predicting VTE risk in patients undergoing surgery for foot and ankle fractures that is usable and scalable in clinical practice. METHODS A retrospective review of 15,342 patients, within the ACS-NSQIP database, who had undergone surgical repair of foot and ankle fractures from 2015 to 2019 was performed. Univariate analysis evaluated differences in demographics and comorbidities. Stepwise multivariate logistic regression was generated based on a 60 % development cohort to evaluate risk factors for VTE. A receiver operator curve based on the 40 % test cohort calculated area under the curve (AUC) to measure the accuracy of the model in predicting VTE within the 30-day postoperative period. RESULTS Of the 15,342 patients, 1.2 % patients experienced VTE, and 98.8 % patients did not. Patients who experienced VTE were significantly older and had an overall higher comorbidity burden. Those who had VTE spent on average 10.5 more minutes in the operating room. In the final model, age over 65, diabetes, dyspnea, CHF, dialysis, wound infection and bleeding disorders were all found to be significant predictors of VTE after controlling for all other factors. The model generated an AUC of 0.731, indicating good predictive accuracy. The predictive model is publicly available at https://shinyapps.io/VTE_Prediction/. CONCLUSIONS In alignment with previous studies, we identified increased age and bleeding disorders as independent risk factors for VTE after foot and ankle fracture surgery. This is one of the first studies to generate and test a model for identifying patients at risk for VTE in this population. This evidence-based model may help surgeons prospectively identify high-risk patients who may benefit from pharmacologic VTE prophylaxis.
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Affiliation(s)
- Jane Brennan
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA.
| | - David Keblish
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA
| | - Elizabeth Friedmann
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA
| | - Adrienne Spirt
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA
| | - Edward Holt
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA
| | - Justin Turcotte
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Annapolis, MD 21401, USA
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Henson P, Shuman WH, Li AY, Ali M, Kalagara R, Hrabarchuk E, Schupper AJ, Steinberger J, Gal JS, Choudhri TF. Seasonal Effects on Postoperative Complications After Spinal Surgery: A National Database Analysis. World Neurosurg 2023; 170:e455-e466. [PMID: 36375802 DOI: 10.1016/j.wneu.2022.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the role of seasonality on postoperative complications after spinal surgery. METHODS Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2018. Current Procedural Terminology codes were used to identify the following procedures: posterior cervical decompression and fusion, cervical laminoplasty, posterior lumbar fusion, lumbar laminectomy, and spinal deformity surgery. The database was queried for deep vein thrombosis (DVT), pulmonary embolism, pneumonia, sepsis, septic shock, Clostridium difficile infection, stroke, cardiac arrest, myocardial infarction, urinary tract infection (UTI), and early unplanned hospital readmission (readmission). Warm season was defined as April-September, whereas cold season was defined as October-March. Statistical analysis included computing overall complication rates and comparison between seasons using univariate analysis and multivariable logistic regression. RESULTS A total of 208,291 individuals underwent spinal surgery from 2011 to 2018. There was a statistically significant increase in UTI (odds ratio [OR], 1.16; 95% confidence interval [CI], 1.07-1.26; P = 0.0002) and readmission (OR, 1.06; 95% CI, 1.02-1.11, P = 0.007) in the warm season compared with the cold season. An investigation into the July effect showed increases in DVT (OR, 1.24; 95% CI, 1.03-1.48; P = 0.020) and thromboembolic events (OR 1.17; 95% CI, 1.01-1.35; P = 0.032) in July-September compared with the preceding 3 months. CONCLUSIONS The results showed a higher incidence of UTI and readmission among spine surgery patients in the warm season and a higher incidence of DVT and thromboembolic events from July to September. In both cases, the effect of seasonality is statistically significant, but the absolute difference is small and may not suggest policy changes.
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Affiliation(s)
- Philip Henson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA.
| | - William H Shuman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Adam Y Li
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Eugene Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Alex J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Jeremy Steinberger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Jonathan S Gal
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
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Chen HW, Wu WT, Wang JH, Lin CL, Hsu CY, Yeh KT. The Risk of Venous Thromboembolism after Thoracolumbar Spine Surgery: A Population-Based Cohort Study. J Clin Med 2023; 12:jcm12020613. [PMID: 36675542 PMCID: PMC9863533 DOI: 10.3390/jcm12020613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Background: Although venous thromboembolism (VTE) is rare, including deep vein thrombosis (DVT) and pulmonary embolism (PE), it is a catastrophic complication after spinal surgery. This study was aimed to investigate the risk factors and incidence of VTE after thoracolumbar spine surgery (TLSS). Methods: We retrieved the data of 8697 patients >20 years old who underwent TLSS between 2000 and 2013 from Taiwan’s Longitudinal Health Insurance Database 2000. Each patient was randomly frequency-matched with four individuals who did not undergo TLSS by age, sex, and index year (the control group). Results: The incidence rates of VTE in the TLSS and control groups were 1.84 and 0.69 per 1000 person-years, respectively. The TLSS group had a higher VTE risk (adjusted HR (aHR): 2.13, 95% confidence interval [95%CI]: 1.41−3.21), DVT (aHR: 2.20, 95%CI: 1.40−3.46), and PE (aHR: 1.60, 95%CI: 0.68−3.78) than the control group. The correlated risk factors of VTE included older age (50−64 years: aHR: 2.16, 95%CI: 1.14−4.09; ≥65 years: aHR: 3.18, 95%CI: 1.65−6.13), a history of cancer (aHR: 2.96, 95%CI: 1.58−5.54), heart failure (aHR: 2.19, 95%CI: 1.27−3.78), and chronic kidney disease (aHR: 1.83, 95%CI: 1.18−2.83). Conclusions: The overall VTE risk following TLSS was less than 2% but correlated with certain risk factors. This information could help the spine surgeon help the patient prevent this fatal complication.
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Affiliation(s)
- Hao-Wen Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Wen-Tien Wu
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
| | - Chung-Yi Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung 404, Taiwan
| | - Kuang-Ting Yeh
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +886-3-8561825-14713
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Yan X, Huang K, Jia M, Yang J, Zhang P, He Y, Lai J, Chen M, Fan S, Li S, Teng H. Construction and verification of a nomogram predicting the risk of preoperative deep vein thrombosis progression after elective spine surgery. Clin Neurol Neurosurg 2022; 222:107439. [PMID: 36152418 DOI: 10.1016/j.clineuro.2022.107439] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to construct and verify a useful nomogram that predicts the risk of preoperative deep vein thrombosis (DVT) progression after elective spine surgery. METHODS Data of patients were collected from 366 patients with preoperative DVT who underwent elective spine surgery at our hospital between July 2017 and May 2022. The least absolute shrinkage and selection operator method combined with multivariable logistic regression analysis were applied to select features for the preoperative DVT progression risk model. The model's capability was evaluated using the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. The decision curve and bootstrapping were used to analyze the clinical value of the nomogram. RESULT A total of 366 DVT patients were enrolled in this study. Preoperative DVT progression after elective spine surgery was 24.04% (88 cases). Among these patients, 86 patients had thrombosis extending into a proximal vein or appearing in a different branch of the vein, either ipsilateral or contralateral, and two had a symptomatic pulmonary embolism. D-dimer, lower extremity varicosities, hyperlipidemia, lower limb paralysis, and operation time were among the predictors in the nomogram. Furthermore, the C-index of the prediction nomogram was 0.805 (95％ CI: 0.754-0.856), with an interval bootstrapping validation of 0.786 and an area under the ROC curve value of 0.800. According to the calibration curves and decision curve analysis, the nomogram could accurately predict the probability of preoperative DVT progression after elective spine surgery. CONCLUSION The advantages of the nomogram included the unique discrimination capability, clinical utility, and predictive accuracy, which was beneficial for clinicians to distinguish high-risk groups of DVT progression after elective spine surgery and formulate relevant prevention measures.
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Affiliation(s)
- Xin Yan
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Kelun Huang
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Mengxian Jia
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Jiali Yang
- Department of Pediatric Allergy and Immunology, The Second Affiliated Hospital and Yuying Children' s Hospital of Wenzhou Medical University, Wenzhou 325027, China.
| | - Peng Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Yaozhi He
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Jiaxin Lai
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Minghang Chen
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Shikang Fan
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Sheng Li
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
| | - Honglin Teng
- Department of Spine Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
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Bhambhvani HP, Kasman AM, Zhang CA, Hu SS, Eisenberg ML. Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis. Global Spine J 2022; 12:663-667. [PMID: 33047620 PMCID: PMC9109564 DOI: 10.1177/2192568220962435] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVES Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine. METHODS We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE. RESULTS We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE. CONCLUSIONS DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.
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Affiliation(s)
| | | | | | - Serena S. Hu
- Stanford University Medical Center,
Stanford, CA, USA
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12
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Kobayashi M, Demura S, Kato S, Yoshioka K, Shinmura K, Yokogawa N, Yonezawa N, Handa M, Annen R, Yamada Y, Nagatani S, Tsuchiya H. Prevalence and risk factors for the development of venous thromboembolism after spinal tumor surgery. World Neurosurg 2022; 164:e177-e182. [DOI: 10.1016/j.wneu.2022.04.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022]
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Louie PK, Urakawa H, Manzur MK, Craig CM, Qureshi SA. Narrative Review of Antiplatelet and Anticoagulant Medications for Venous Thromboembolism Prevention in Spine Surgery. Clin Spine Surg 2022; 35:63-75. [PMID: 34694260 DOI: 10.1097/bsd.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVE The objective of this study was to identify commonly utilized venous thromboembolism (VTE) prophylactic measures, spine surgeon perspective, and provide pharmacologic recommendations from the literature. SUMMARY OF BACKGROUND DATA Considered a preventable cause of morbidity and mortality, VTE remains an important iatrogenic diagnosis of concern. Reported rates of VTE following spine surgery vary widely (0.3%-31.0%). MATERIALS AND METHODS A MEDLINE query identified literature reporting on VTE prevention and outcomes in the setting of spine surgery. Findings extracted from the included articles were summarized in a narrative review format to identify salient aspects of the current literature. RESULTS Sixty articles were summarized. Many anticoagulation medications that are described in the literature target factors involved in the coagulation cascade common pathway including aspirin and other antiplatelet medications, heparins, and warfarin. Newer direct inhibitors of thrombin and factor Xa are now being utilized for VTE prevention, although with limited use specifically in spine surgery. CONCLUSIONS Perioperative management of antiplatelet and anticoagulation medications in spine surgery requires evidence-based protocols that can account for patient comorbidities and surgery-specific features. Future studies should prospectively focus on establishing stronger recommendations based on pathology, surgical indications, patient comorbidities, region of the spine, and broad surgical intervention to enable effective prophylaxis for VTE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
| | | | - Mustfa K Manzur
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Chad M Craig
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medical College, New York, NY
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15
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Hoang H, Sharfman Z, Gelfand Y, Ramos RLG, Gomez J, Krystal J, Kramer D, Yassari R. Cigarette smoking and complications in elective thoracolumbar fusions surgery: An analysis of 58,304 procedures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:169-174. [PMID: 35837438 PMCID: PMC9274679 DOI: 10.4103/jcvjs.jcvjs_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/01/2022] [Indexed: 11/04/2022] Open
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Bui A, Lashkari N, Formanek B, Wang JC, Buser Z, Liu JC. Incidence and Risk Factors for Postoperative Venous Thromboembolic Events in Patients Undergoing Cervical Spine Surgery. Clin Spine Surg 2021; 34:E458-E465. [PMID: 33605609 DOI: 10.1097/bsd.0000000000001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective database study. OBJECTIVE The objective of this study was to investigate preoperative risk factors and incidence of venous thromboembolic events (VTEs) after cervical spine surgery. SUMMARY OF BACKGROUND DATA VTEs are preventable complications that may occur after spinal procedures. Globally, VTEs account for a major cause of morbidity and mortality. Preoperative risks factors associated with increased VTE incidence after cervical spine surgery have not been well-characterized. MATERIALS AND METHODS Patients undergoing anterior cervical discectomy and fusion (ACDF); posterior cervical fusion (PCF); discectomy; and decompression from 2007 to 2017 were identified using the PearlDiver Database. International Classification of Diseases (ICD) Ninth and 10th Revision codes were used to identify VTEs at 1 week, 1 month, and 3 months postoperative as well as preoperative risk factors. RESULTS Risk factors with the highest incidence of VTE at 3 months were primary coagulation disorder [ACDF=7.82%, odds ratio (OR)=3.96; decompression=11.24%, OR=3.03], central venous line (ACDF=5.68%, OR=2.11; PCF=12.58%, OR=2.27; decompression=10.17%, OR=2.80) and extremity paralysis (ACDF=6.59%, OR=2.73; PCF=18.80%, OR=2.99; decompression=11.86, OR=3.74). VTE incidence at 3 months for populations with these risks was significant for all surgery types (P<0.001) with the exception of patients with primary coagulation disorder who underwent PCF. Tobacco use had the lowest VTE incidence for all surgery types. CONCLUSIONS The total cumulative incidence of VTEs at 3-month follow-up was 3.10%, with the highest incidence of VTEs occurring within the first postoperative week (0.65% at 1 wk, 0.61% at 1 mo, 0.53% at 3 mo for ACDF; 2.56% at 1 wk, 1.93% at 1 mo, 1.45% at 3 mo for PCF; 1.37% at 1 wk, 0.93% at 1 mo, 0.91% at 3 mo for decompression). Several preoperative risk factors were found to be significant predictors for postoperative VTEs and can be used to suggest those at increased risk as well as decrease the incidence of preventable VTEs after cervical spine surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | | | - John C Liu
- Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Yue L, Fu HY, Sun HL. Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery: A case report and review of literature. World J Clin Cases 2021; 9:7490-7497. [PMID: 34616817 PMCID: PMC8464458 DOI: 10.12998/wjcc.v9.i25.7490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/04/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Deep venous thrombosis (DVT) is a serious complication of lumbar spine surgery. Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery. May-Thurner syndrome (MTS), a venous anatomical variation that may require invasive intervention, is an often overlooked cause of DVT. To date, no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.
CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery, and MTS was only considered after surgery, during a review of a gynecological enhanced computed tomography image taken before the procedure.
CONCLUSION In conclusion, clinicians should consider MTS in the presence of a dangerous triad: spondylolisthesis, elevated D-dimer levels, and sonographically indicated unilateral deep vein dilation. Consultation with a vascular surgeon is also essential to MTS management.
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Affiliation(s)
- Lei Yue
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-Yong Fu
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
| | - Hao-Lin Sun
- Department of Orthopedics, Peking University First Hospital, Beijing 100034, China
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Zhang HR, Xu MY, Yang XG, Wang F, Zhang H, Yang L, Qiao RQ, Li JK, Zhao YL, Zhang JY, Hu YC. Nomogram for Predicting the Postoperative Venous Thromboembolism in Spinal Metastasis Tumor: A Multicenter Retrospective Study. Front Oncol 2021; 11:629823. [PMID: 34249679 PMCID: PMC8264656 DOI: 10.3389/fonc.2021.629823] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/14/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction Venous thromboembolism can be divided into deep vein thrombosis and pulmonary embolism. These diseases are a major factor affecting the clinical prognosis of patients and can lead to the death of these patients. Unfortunately, the literature on the risk factors of venous thromboembolism after surgery for spine metastatic bone lesions are rare, and no predictive model has been established. Methods We retrospectively analyzed 411 cancer patients who underwent metastatic spinal tumor surgery at our institution between 2009 and 2019. The outcome variable of the current study is venous thromboembolism that occurred within 90 days of surgery. In order to identify the risk factors for venous thromboembolism, a univariate logistic regression analysis was performed first, and then variables significant at the P value less than 0.2 were included in a multivariate logistic regression analysis. Finally, a nomogram model was established using the independent risk factors. Results In the multivariate logistic regression model, four independent risk factors for venous thromboembolism were further screened out, including preoperative Frankel score (OR=2.68, 95% CI 1.78-4.04, P=0.001), blood transfusion (OR=3.11, 95% CI 1.61-6.02, P=0.041), Charlson comorbidity index (OR=2.01, 95% CI 1.27-3.17, P=0.013; OR=2.29, 95% CI 1.25-4.20, P=0.017), and operative time (OR=1.36, 95% CI 1.14-1.63, P=0.001). On the basis of the four independent influencing factors screened out by multivariate logistic regression model, a nomogram prediction model was established. Both training sample and validation sample showed that the predicted probability of the nomogram had a strong correlation with the actual situation. Conclusion The prediction model for postoperative VTE developed by our team provides clinicians with a simple method that can be used to calculate the VTE risk of patients at the bedside, and can help clinicians make evidence-based judgments on when to use intervention measures. In clinical practice, the simplicity of this predictive model has great practical value.
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Affiliation(s)
- Hao-Ran Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Ming-You Xu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Xiong-Gang Yang
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Wang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Hao Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Li Yang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Rui-Qi Qiao
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Ji-Kai Li
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Yun-Long Zhao
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Jing-Yu Zhang
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Yong-Cheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
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Wang KY, Ikwuezunma I, Puvanesarajah V, Babu J, Margalit A, Raad M, Jain A. Using Predictive Modeling and Supervised Machine Learning to Identify Patients at Risk for Venous Thromboembolism Following Posterior Lumbar Fusion. Global Spine J 2021; 13:1097-1103. [PMID: 34036817 DOI: 10.1177/21925682211019361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE To use predictive modeling and machine learning to identify patients at risk for venous thromboembolism (VTE) following posterior lumbar fusion (PLF) for degenerative spinal pathology. METHODS Patients undergoing single-level PLF in the inpatient setting were identified in the National Surgical Quality Improvement Program database. Our outcome measure of VTE included all patients who experienced a pulmonary embolism and/or deep venous thrombosis within 30-days of surgery. Two different methodologies were used to identify VTE risk: 1) a novel predictive model derived from multivariable logistic regression of significant risk factors, and 2) a tree-based extreme gradient boosting (XGBoost) algorithm using preoperative variables. The methods were compared against legacy risk-stratification measures: ASA and Charlson Comorbidity Index (CCI) using area-under-the-curve (AUC) statistic. RESULTS 13, 500 patients who underwent single-level PLF met the study criteria. Of these, 0.95% had a VTE within 30-days of surgery. The 5 clinical variables found to be significant in the multivariable predictive model were: age > 65, obesity grade II or above, coronary artery disease, functional status, and prolonged operative time. The predictive model exhibited an AUC of 0.716, which was significantly higher than the AUCs of ASA and CCI (all, P < 0.001), and comparable to that of the XGBoost algorithm (P > 0.05). CONCLUSION Predictive analytics and machine learning can be leveraged to aid in identification of patients at risk of VTE following PLF. Surgeons and perioperative teams may find these tools useful to augment clinical decision making risk stratification tool.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ijezie Ikwuezunma
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jacob Babu
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Adam Margalit
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, 1501The Johns Hopkins Hospital, Baltimore, MD, USA
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Shahrestani S, Ballatori AM, Chen XT, Ton A, Buser Z, Wang JC. Identifying risks factors in thoracolumbar anterior fusion surgery through predictive analytics in a nationally representative inpatient sample. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:669-677. [PMID: 33948749 DOI: 10.1007/s00586-021-06857-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Anterior thoracolumbar (TL) surgical approaches provide more direct trajectories compared to posterior approaches. Proper patient selection is key in identifying populations that may benefit from anterior TL fusion. Here, we utilize predictive analytics to identify risk factors in anterior TL fusion in patients with trauma and deformity. METHODS In this retrospective cohort study of patients receiving anterior TL fusion (between and including T12/L1), population-based regression models were developed to identify risk factors using the National Readmission Database 2016-2017. Readmissions were analyzed at 30- and 90-day intervals. Risk factors included hypertension, obesity, malnutrition, smoking, alcohol use, long-term opioid use, and frailty. Multivariate regression models were developed to determine the influence of each risk factor on complication rates. RESULTS A total of 265 and 375 patients were identified for the scoliosis and burst fracture cohorts, respectively. In patients with scoliosis, alcohol use was found to increase the length of stay (LOS) (p = 0.00061) and all-payer inpatient cost following surgery (p = 0.014), and frailty was found to increase the inpatient LOS (p = 0.0045). In patients with burst fractures, malnutrition was found to increase the LOS (p < 0.0001) and all-payer cost (p < 0.0001), obesity was found to increase the all-payer cost (p = 0.012), and frailty was found to increase the all-payer cost (p = 0.031) and LOS (p < 0.0001). DISCUSSION Patient-specific risk factors in anterior TL fusion surgery significantly influence complication rates. An understanding of relevant risk factors before surgery may facilitate preoperative patient selection and postoperative patient triage and risk categorization.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Department of Medical Engineering, California Institute of Technology, Pasadena, CA, USA. .,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Alexander M Ballatori
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Xiao T Chen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andy Ton
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Zorica Buser
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Jeffrey C Wang
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Zambelli R, Nemeth B, Touw CE, Rosendaal FR, Rezende SM, Cannegieter SC. High risk of venous thromboembolism after orthopedic surgery in patients with thrombophilia. J Thromb Haemost 2021; 19:444-451. [PMID: 33174335 DOI: 10.1111/jth.15163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed at evaluating the effect of thrombophilia on the risk of venous thromboembolism (VTE) in patients undergoing any type of orthopedic surgery. BACKGROUND Patients undergoing orthopedic surgery are at high risk for VTE. Although patients with thrombophilia have an increased risk of VTE, it is currently unclear whether there is a synergetic effect in patients with thrombophilia who undergo orthopedic surgery. METHODS Data from a large population-based case-control study (the Multiple Environmental and Genetic Assessment [MEGA] of risk factors for venous thrombosis study) were used. Odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for age, sex, and body mass index (BMI) (ORadj) were calculated for patients undergoing any orthopedic intervention. RESULTS Of 4721 cases and 5638 controls, 263 cases and 94 controls underwent orthopedic surgery. Patients who had any orthopedic intervention in the year before the index date were at higher risk of VTE (ORadj 3.7; 95% CI, 2.9-4.8) than those who did not undergo any orthopedic surgery. There was an additionally increased risk in patients with factor V Leiden (OR 17.5, 95% CI, 4.1-73.6), non-O blood group (OR 11.2; 95% CI, 3.4-34.0), or elevated plasma levels of factor VIII (OR 18.6; 95% CI, 7.4-46.9) all relative to patients without these defects, not undergoing orthopedic surgery. CONCLUSIONS Patients with factor V Leiden, high levels of factor VIII, or blood group non-O were found to have a high risk of VTE after orthopedic surgery. Identification of these patients may enable individualized thromboprophylactic treatment to efficiently reduce VTE risk.
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Affiliation(s)
- Roberto Zambelli
- Department of Orthopedic Surgery, Rede Mater Dei de Saúde, Belo Horizonte, Brazil
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Banne Nemeth
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carolina E Touw
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Suely M Rezende
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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22
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Chilkoti GT, Jain N, Mohta M, Saxena AK. Perioperative concerns in Pott's spine: A review. J Anaesthesiol Clin Pharmacol 2021; 36:443-449. [PMID: 33840921 PMCID: PMC8022046 DOI: 10.4103/joacp.joacp_167_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/29/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
Pott's disease is the most common granulomatous spine infection caused by tubercle bacilli and is a common site of osseous tuberculosis, accounting for 50–60% of cases. The delay in establishing diagnosis and management results in complications such as spinal cord compression and spinal deformity. The aim of this narrative review is to discuss the perioperative concerns in patients for spine surgery. The literature source for this review was obtained via PubMed, Medline, Google Scholar, Cochrane database of systematic reviews, and textbooks until December 2019. On the literature search, we could not retrieve any review article specifically discussing the perioperative concerns of spinal tuberculosis. Therefore, the aim of the present narrative review is to discuss the perioperative concerns of patients for spine surgery along with the specific concerns related to spinal tuberculosis.
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Affiliation(s)
- Geetanjali Tolia Chilkoti
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Nidhi Jain
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Medha Mohta
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Ashok K Saxena
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Fourman MS, Shaw JD, Nwasike CO, Boakye LAT, Dombrowski ME, Vaudreuil NJ, Wawrose RA, Lunardini DJ, Lee JY. Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism. Global Spine J 2020; 10:844-850. [PMID: 32905722 PMCID: PMC7485070 DOI: 10.1177/2192568219878418] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients. METHODS Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion. RESULTS A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients (P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent. CONCLUSIONS Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.
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Affiliation(s)
| | - Jeremy D. Shaw
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | | | | | - Joon Y. Lee
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA,Joon Y. Lee, University of Pittsburgh Medical Center, Suite 1010, Kaufmann Medical Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Abstract
BACKGROUND To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery. METHODS Literature published in PubMed, Embase, the Cochrane Library, and Web of Science was systematically reviewed to assess risk factors for VTE following spinal surgery. The data analysis was conducted with STATA 12.0. Data were pooled using fixed-effects or random-effects models according to the heterogeneity among the included studies. RESULTS Twenty-six studies involving 3,216,187 patients were included in this meta-analysis, and the total incidence of VTE after spinal surgery was 0.35% (0.15-29.38%). The pooled analysis suggested that the incidence of VTE after spinal surgery was higher in such aspects as increasing age (weighted mean difference [WMD] 0.55 years, 95% confidence interval [CI] 0.33-0.78, P < .001), female sex (odds ratio [OR] 1.12, 95% CI 1.01-1.25; P = .034), diabetes (OR 1.34, 95% CI 1.29-1.44; P < .001), chronic kidney disease (OR = 8.31, 95% CI 1.98-34.93; P = .004), nonambulatory preoperative activity status (OR 3.67, 95% CI 2.75-4.83; P < .001), D-dimer level (WMD 1.023, 95% CI 0.162-1.884; P = .02), long duration of operation (WMD 0.73, 95% CI 0.21-1.24; P = .006), spine fusion (OR 1.54, 95% CI 1.31-1.82; P < .001), and blood transfusion (OR 2.31, 95% CI 1.73-3.07; P < .001), and the differences were statistically significant. However, there were no significant differences in body mass index, obesity, hypertension, coronary heart disease, spondylolisthesis, intraoperative blood loss, surgical procedures (anterior lumbar interbody fusion vs posterior intervertebral fusion /translaminar lumbar interbody fusion), or surgical site (lumbar vs thoracic) (all P > .05). CONCLUSION Based on our meta-analysis, we identified several important factors that increased the risk of VTE after spinal surgery. We hope our study provides assistance to spine surgeons so that they can adequately analyze and assess risk factors in patients and then develop preventive measures to reduce the incidence of VTE.
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Affiliation(s)
- Lu Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University and Spine and Spinal Cord Disease Research Center, Shandong University
| | - Hongxin Cao
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yunzhen Chen
- Department of Orthopedics, Qilu Hospital of Shandong University and Spine and Spinal Cord Disease Research Center, Shandong University
| | - Guangjun Jiao
- Department of Orthopedics, Qilu Hospital of Shandong University and Spine and Spinal Cord Disease Research Center, Shandong University
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Cloney MB, Driscoll CB, Yamaguchi JT, Hopkins B, Dahdaleh NS. Comparison of inpatient versus post-discharge venous thromboembolic events after spinal surgery: A single institution series of 6869 consecutive patients. Clin Neurol Neurosurg 2020; 196:105982. [PMID: 32570019 DOI: 10.1016/j.clineuro.2020.105982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 11/19/2022]
Abstract
STUDY DESIGN retrospective chart review. OBJECTIVE We aimed to determine the perioperative risk factors that lead to inpatient or post-discharge venous thromboembolism (VTE) events after spinal surgery. SUMMARY OF BACKGROUND DATA While many studies relate the risk factors in a post-surgical setting to the incidence of VTE, this study aims to separate these VTE into inpatient and post-discharge categories to examine timing and risk factors. METHODS We analyzed 6869 patients from 2009 to 2015 using Current Procedural Technology codes from a single tertiary academic institution. Patients were stratified based on occurrence and setting of VTE then controlled for perioperative characteristics with exclusion criteria being patients undergoing minor spine surgeries or secondary procedures. RESULTS In 170 VTE events, these factors were associated with increased risk for: Inpatient DVT only: IVC filter (OR 6.380 [3.414-11.924]), longer length of hospital stay (OR 1.083 [1.047-1.120]), a prior history of DVT (OR 3.640 [1.931-6.856]). Post-discharge DVT only: history of PE (OR 45.142 [6.785-300.351]), having a corpectomy (OR 26.670 [3.477-204.548]), and having an osteotomy (OR 18.877 [1.129-315.534]). Inpatient PE only: surgery >4 h (OR 30.820, p < 0.001), fracture (OR 6.913, p = 0.004), IVC filter (OR 3.135, p = 0.029). Post-discharge PE only: corpectomy (OR 541.271, p = 0.009), foraminotomy (OR 40.137, p = 0.013), EBL > 500cc (OR 2467.798, p = 0.002). Time to onset of VTE events was significantly longer for patients undergoing osteotomy (7.43 days) than for patients with fracture (4.28 days), which is consistent with our findings that fracture was an independent predictor of inpatient VTE, and osteotomy was an independent predictor of post-discharge VTE (p = 0.018). CONCLUSIONS Time-to-VTE varies between types of surgeries. Some risk factors are independently associated with VTE at all times during the 30-day postoperative period, while other factors are only associated with either inpatient or post-discharge VTE. Those patients with high-risk features for post-discharge VTE merit increased study for thromboprophylaxis management.
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Affiliation(s)
- Michael B Cloney
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, United States.
| | - Conor B Driscoll
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, United States.
| | - Jonathan T Yamaguchi
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, United States.
| | - Benjamin Hopkins
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, United States.
| | - Nader S Dahdaleh
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 676 North St. Clair Street, NMH/Arkes Family Pavilion Suite 2210, Chicago, IL, United States.
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Jannati M, Ardecani AA. Prevention of Pulmonary and Venous Thromboembolism Post Coronary Artery Bypass Graft Surgery - Literature Review. Braz J Cardiovasc Surg 2020; 35:368-374. [PMID: 32549108 PMCID: PMC7299585 DOI: 10.21470/1678-9741-2018-0345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective The current review evaluates recent literature on the different aspects of prophylaxis in postoperative pulmonary and venous thromboembolism and their main risk factors. Methods The literature survey was carried out based on the PubMed data using the keywords “coronary artery bypass graft” and “venous thromboembolism” as components of the search field title. Results Studies reported several risk factors for postoperative thromboembolism including advanced age, postoperative immobilization, type of thromboprophylaxis, obesity, and location of the surgery. Conclusion According to the studies, tailored prophylaxis could be easily adapted to decrease the intensity and duration of postoperative thromboembolism in a patient with several disorders and comorbidities, especially in cardiovascular disease.
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Affiliation(s)
- Mansour Jannati
- Shiraz University of Medical Sciences Faghihi Hospital Department of Cardiovascular Surgery Shiraz Iran Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Abdi Ardecani
- Shiraz University of Medical Sciences Faghihi Hospital Department of Cardiovascular Surgery Shiraz Iran Department of Cardiovascular Surgery, Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Park JH, Park S, Choi SA. Incidence and risk factors of spinal epidural hemorrhage after spine surgery: a cross-sectional retrospective analysis of a national database. BMC Musculoskelet Disord 2020; 21:324. [PMID: 32450822 PMCID: PMC7249427 DOI: 10.1186/s12891-020-03337-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/08/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND With increasing number of patients undergoing spine surgery, the spinal epidural hemorrhage (SEH) has become a growing concern. However, current studies on SEH rely on case reports or observations from a single center. Our study attempted to demonstrate the incidence rate and risk factors of SEH using a national dataset. METHODS A total of 17,549 spine surgery cases from the Health Insurance Review and Assessment Service National Inpatient Sample of 2014 were analyzed. After evaluating the incidence of SEH based on severe cases requiring reoperation, a univariate comparison was performed. Variables found to be significant were included in a multivariable analysis model to determine the risk factors. RESULTS The incidence of SEH was found to be 1.15% in Korean population, and there were no severe SEH cases. Our analysis confirmed the previous findings that lumbar surgery, intraoperative blood loss, prolonged surgical time, high blood pressure, use of nonsteroidal anti-inflammatory drugs, and concurrent bleeding factors are the risk factors of SEH. Anterior approach showed a protective effect. The use of anticoagulant demonstrated no statistical significance. CONCLUSION Although severe SEH cases were not detected, the incidence of SEH was similar to that reported in literature. Given that SEH is a rare complication of spine surgery and constitutes an important research area that needs to be studied further, our study makes a meaningful contribution based on a rigorous national level sample for the first time and provides the academic circle and health professionals with a reliable evidence of improved clinical outcomes in such cases.
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Affiliation(s)
- Ji Hyun Park
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong-si, 30019 South Korea
| | - Sunny Park
- Research Institute of Pharmaceutical Sciences and Technology, Korea University College of Pharmacy, 2511 Sejong-ro, Sejong-si, 30019 South Korea
| | - Soo An Choi
- College of Pharmacy, Korea University, 2511 Sejong-ro, Sejong-si, 30019 South Korea
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Kaewborisutsakul A, Tunthanathip T, Yuwakosol P, Inkate S, Pattharachayakul S. Postoperative Venous Thromboembolism in Extramedullary Spinal Tumors. Asian J Neurosurg 2020; 15:51-58. [PMID: 32181173 PMCID: PMC7057870 DOI: 10.4103/ajns.ajns_279_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/13/2019] [Indexed: 12/11/2022] Open
Abstract
Context: Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), is the fatal complication following spine surgery and the appropriate perioperative prophylaxis is still debated. Aims: The aim of this study is to evaluate the incidence of along with risk factors for postoperative VTE in surgically treated extramedullary spinal tumor patients. Setting and Designs: The study design involves single institute and retrospective cohort study. Subjects and Methods: The cohort database was reviewed between the periods of January 2014 and June 2019. Patients undergoing surgery for spine tumor, extradural tumor, and intradural extramedullary were consecutively collected. Statistical Analysis Used: The incidence of VTE and clinical factors reported to be associated with VTE were identified, and then analyzed with an appropriate Cox regression model. Results: The study identified 103 extramedullary spinal tumor patients. Three patients (2.9%) were diagnosed with a proximal leg DVT, while symptomatic PE did not identify. Risk factors associated with DVT occurrence were as follows: operative time ≥8 h (Hazard ratio [HR] 13.98, P = 0.03) and plasma transfusion (HR 16.38, P = 0.02), whereas plasma transfusion was the only significant factor, after multivariate analysis (HR 11.77, P = 0.05). Conclusions: Patients who underwent surgery for extramedullary spinal tumors showed a 2.9% incidence of DVT. The highest rate of DVT was found in patients who received plasma transfusion. More attention should be paid on perioperative associated factors for intensive prevention coupled with early screening in this group.
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Affiliation(s)
- Anukoon Kaewborisutsakul
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Thara Tunthanathip
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Pakorn Yuwakosol
- Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Srirat Inkate
- Division of Nursing Services, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
| | - Sutthiporn Pattharachayakul
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat-Yai, Songkhla, Thailand
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Abstract
STUDY DESIGN Retrospective database analysis. OBJECTIVE The aim of this study was to match risk factors for complications in patients who did and did not sustain a dural tear while undergoing posterior lumbar spine surgery and compare local and systemic complications. SUMMARY OF BACKGROUND DATA Current data do not adequately define whether the event of sustaining an isolated dural tear increases the risk for postoperative complications while controlling for other confounding risk factors. METHODS The PearlDiver Database was queried for patients who underwent posterior lumbar spine decompression and/or fusion for degenerative pathology. Patients with and without dural tears were 1:2 matched based on demographic variables and comorbidities. Complications, cost, length of stay (LOS), and readmission rates were analyzed. RESULTS The 1:2 matched cohort included 9038 patients with a dural tear and 17,340 patients without a dural tear. All complications assessed were significantly higher in the dural tear group (P < 0.03). Venothromboembolic (VTE) events occurred in 1.3% of patients with a dural tear and 0.9% of patients without a dural tear (odds ratio [OR] 1.46, P < 0.0001). Meningitis occurred in 25 patients (0.3%) with a dural tear and eight patients (<0.1%) without a dural tear (OR 6.0, P < 0.0001). Patients with a dural tear had 120% higher medical costs, 200% greater LOS, and were two times more likely to be readmitted (P < 0.0001). CONCLUSION Sustaining a dural tear while undergoing posterior lumbar spinal decompression and/or fusion for degenerative pathology significantly increased the risk of complications and increased length of stay, risk of readmission, and overall 90-day hospital cost. Dural tears specifically increased the risk of a VTE complication by 1.46 times and meningitis by six times; these are important complications to have a high degree of suspicion for in the setting of durotomy, as they can lead to significant morbidity for the patient. LEVEL OF EVIDENCE 3.
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Time-to-event analyses of lower-limb venous thromboembolism in aged patients undergoing lumbar spine surgery: a retrospective study of 1620 patients. Aging (Albany NY) 2019; 11:8701-8709. [PMID: 31613794 PMCID: PMC6814587 DOI: 10.18632/aging.102364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/07/2019] [Indexed: 12/26/2022]
Abstract
After spine surgery, venous thromboembolism (VTE) is not uncommon in aged patients. This study investigates time-to-event risk factors of postoperative VTE based on medical records of aged patients (age≥60 yr) between January 2013 and December 2018. All participants had undergone lower extremity ultrasonography pre- and postoperatively at the first, second, fourth, eighth, and twelfth weeks. Mann-Whitney U tests and chi-square tests were used for univariate analyses, and Cox regression was utilized for multivariate analyses. A total of 1620 cases were recruited, VTE group (N=382, 23.6%) and non-VTE group (N=1238, 76.4%), aged 67 (IQR 11) years and 65 (IQR 6) years, respectively. The univariate analyses indicated significant differences between the VTE and non-VTE groups regarding advanced age, VTE history, hypertension, fusion, hospital stay, FIB, HDL, D-dimer, and TC (all P<0.05). The Cox regression showed that advanced age (OR=1.108; 95% CI, 1.091–1.126), VTE history (OR=4.962; 95% CI, 3.849–6.397), and hypertension (OR=1.344; 95% CI, 1.084–1.667) were the risk factors for postoperative VTE (P<0.05). The time-to-event analyses indicated that the hazard of VTE formation was highest in the first postoperative week. In conclusion, advanced age, VTE history, and hypertension are main risks for VTE formation, particularly in the first postoperative week.
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Badiee RK, Chan AK, Rivera J, Molinaro A, Doherty BR, Riew KD, Chou D, Mummaneni PV, Tan LA. Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery. Neurospine 2019; 16:548-557. [PMID: 31607087 PMCID: PMC6790747 DOI: 10.14245/ns.1938198.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery. METHODS Adults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery. RESULTS A total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p=0.02) and estimated blood loss over 500 mL (OR, 3.67; p=0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p=0.02) and operative time (OR, 1.005; p=0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p=0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p=0.04) and higher intraoperative blood loss (OR, 1.0007; p=0.03). CONCLUSION Preoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery.
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Affiliation(s)
- Ryan K Badiee
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Andrew K Chan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Joshua Rivera
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Annette Molinaro
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Brianna R Doherty
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - K Daniel Riew
- The Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Dean Chou
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
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Rockson HB, DiPaola CP, Connolly PJ, Stauff MP. Venous Thromboembolism Prophylaxis for Patients Having Elective Spine Surgery: When, Why, and How Much. J Bone Joint Surg Am 2019; 101:1220-1229. [PMID: 31274725 DOI: 10.2106/jbjs.18.00849] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hayden B Rockson
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Christian P DiPaola
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Patrick J Connolly
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
| | - Michael P Stauff
- Division of Spine Surgery (C.P.D., P.J.C., and M.P.S.), Department of Orthopedic Surgery (H.B.R., C.P.D., P.J.C., and M.P.S.), UMass Memorial Medical Center, Worcester, Massachusetts
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Shi W, Schultz S, Gater DR. Severe Leg Pain Following Spinal Cord Stimulator Implantation - A Case Report. PM R 2018; 11:317-321. [PMID: 30217642 DOI: 10.1016/j.pmrj.2018.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022]
Abstract
Following spinal cord stimulator (SCS) implantation, postoperative pain is commonly incisional or neuropathic from neurological damage. Occasionally, this new pain may mimic symptoms caused by preexisting pathology. This article presents a case of immediate, severe, postoperative leg pain secondary to a lower extremity deep vein thrombosis (DVT) and subsequent pulmonary embolism after percutaneous SCS implantation for failed back syndrome. The risk factors of DVT after spine surgery and perioperative prophylaxis are further discussed with a brief literature review. LEVEL OF EVIDENCE: V.
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Affiliation(s)
- Weibin Shi
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medicine Center, Penn State College of Medicine, 1135 Old West Chocolate Avenue, Hummelstown, PA 17036
| | - Shannon Schultz
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medicine Center, Penn State College of Medicine, Hummelstown, PA
| | - David R Gater
- Department of Physical Medicine and Rehabilitation, Penn State Hershey Medicine Center, Penn State College of Medicine, Hummelstown, PA
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Bouyer B, Rudnichi A, Dray-Spira R, Zureik M, Coste J. Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients. J Thromb Haemost 2018; 16:1537-1545. [PMID: 29893460 DOI: 10.1111/jth.14205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 01/24/2023]
Abstract
Essentials The risk of venous thromboembolism (VTE) after lumbar spine surgery (LBS) is not precisely known. More than 320 000 patients who underwent LBS in France between 2009 and 2014 were followed-up. The overall risk of VTE after LBS is less than 1% but modulated by patient and procedural factors. Surgical device implantation, anterior approach and complex surgery increase the risk of VTE. SUMMARY: Background Postoperative venous thromboembolism (VTE) is a severe complication, the risk of which after lumbar spine surgery (LBS) is not precisely known. Objective To estimate the incidence of VTE after LBS, and to identify individual and surgical risk factors. Methods All patients aged >18 years who underwent LBS in France between 2009 and 2014 were identified. Among 477 024 patients screened, exclusions concerned recent VTE or surgery, and multiple surgeries during the same hospital stay. Results In 323 737 patients (mean age 52.9 years, 51.4% male), we observed 2911 events (0.91%) after a median time of 12 days (Q1-Q3: 5-72 days). The multivariate adjusted Cox model showed increased risks associated with age (4% per year of age; 95% confidence interval [CI] 3.8-4.3), obesity (hazard ratio [HR] 1.32, 95% CI 1.18-1.46), active cancer (HR 1.65, 95% CI 1.5-1.82), previous thromboembolism (HR 5.41, 95% CI 4.74-6.17), severe paralysis (HR 1.47, 95% CI 1.17-1.84), renal disease (HR 1.28, 95% CI 1.04-1.6), psychiatric disease (HR 1.21, 95% CI 1.1-1.32), use of antidepressants (HR 1.13, 95% CI 1.03-1.24), use of contraceptives (HR 1.56, 95% CI 1.19-2.03), extended surgery for scoliosis (HR 3.61, 95% CI 2.96-4.4), implantation of pedicular screws with a 'dose-effect' association, and an anterior approach (HR 1.97, 95% CI 1.6-2.43) or a combined approach (HR 2.03, 95% CI 1.44-2.84). Conclusions The overall VTE risk after LBS is moderate (< 1%) but is widely modulated by several easily identifiable risk factors. The surgical community should be aware of this heterogeneity, adapt prevention according to patients and to the procedure, and use drug prophylaxis in the event of a high risk being present.
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Affiliation(s)
- B Bouyer
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
- AP-HP and Paris-Descartes University, Paris, France
- Paris-Sud University, Paris, France
| | - A Rudnichi
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
| | - R Dray-Spira
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
| | - M Zureik
- French National Agency for Medicines and Health Products Safety, Saint Denis, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
| | - J Coste
- AP-HP and Paris-Descartes University, Paris, France
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Abstract
Venous thromboembolism (VTE) is a source of morbidity and mortality in patients undergoing orthopaedic surgery. A substantial body of literature supports the use of VTE prophylactic agents in patients undergoing lower extremity surgery. Treatment options include early mobilization, mechanical prophylaxis via pneumatic compression devices, pharmacologic agents, and venous filters. No consensus has been established regarding utilization or timing of VTE prophylaxis measures after spine surgery. The risk of VTE in patients undergoing spine surgery is not well characterized and varies substantially by the procedure and degree of neurologic compromise. In addition, the risk of clinically notable VTE must be weighed against the risk of postoperative bleeding and epidural hematoma after spine surgery. A standardized approach to VTE prophylaxis in patients undergoing spine surgery must take into account the available studies of risk factors, choice of prophylactic agents, and timing of prophylaxis.
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Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, Hinoul P. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 2018; 229:134-144. [PMID: 29936980 DOI: 10.1016/j.jss.2018.03.022] [Citation(s) in RCA: 474] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/27/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to systematically synthesize the large volume of literature reporting on the association between operative duration and complications across various surgical specialties and procedure types. METHODS An electronic search of PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from January 2005 to January 2015 was conducted. Sixty-six observational studies met the inclusion criteria. RESULTS Pooled analyses showed that the likelihood of complications increased significantly with prolonged operative duration, approximately doubling with operative time thresholds exceeding 2 or more hours. Meta-analyses also demonstrated a 14% increase in the likelihood of complications for every 30 min of additional operating time. CONCLUSIONS Prolonged operative time is associated with an increase in the risk of complications. Given the adverse consequences of complications, decreased operative times should be a universal goal for surgeons, hospitals, and policy-makers. Future study is recommended on the evaluation of interventions targeted to reducing operating time.
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Inaccuracies in ICD Coding for Obesity Would Be Expected to Bias Administrative Database Spine Studies Toward Overestimating the Impact of Obesity on Perioperative Adverse Outcomes. Spine (Phila Pa 1976) 2018; 43:526-532. [PMID: 28767639 DOI: 10.1097/brs.0000000000002356] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine if International Classification of Diseases (ICD) coding for obesity is biased toward certain subgroups and how potential bias may influence the outcomes of database research in spine. SUMMARY OF BACKGROUND DATA There has been increased use of national databases using administrative data in the spine surgery literature. Past research demonstrates that sensitivity of ICD codes for obesity is poor, but it is unknown if such inaccuracies are systematically biased and if they may bias studies utilizing such data. METHODS Patients who underwent elective posterior lumbar fusion, 2013 to 2016, at a large academic hospital were identified. All ICD codes assigned to the encounter were obtained. Body mass index (BMI) was calculated based on height and weight. The sensitivity of ICD coding for obesity was calculated. Sensitivity was compared for subgroups defined by demographic, comorbidity, intraoperative, and postoperative factors. The association of obesity (as defined by BMI≥30 and ICD coding) with 30-day postoperative adverse events was tested with multivariate regression. RESULTS The study included 796 patients. The overall sensitivity of ICD coding for obesity was 42.5%. The sensitivity of ICD coding for obesity was significantly higher in patients with greater BMI, diabetes, American Society of Anesthesiologists class≥III, increased length of stay, venous thromboembolism, any adverse event, and major adverse event. Multivariate analysis for determining outcomes of increased risk with obesity as defined by ICD coding included venous thromboembolism, major adverse events, and any adverse events. However, multivariate analysis for determining outcomes of increased risk with obesity defined by BMI did not yield any positive associations. CONCLUSION ICD codes for obesity are more commonly assigned to patients with other comorbidities or postoperative complications. Further, use of such nonrandomly assigned ICD codes for obesity has the potential to skew studies to suggest greater associated adverse events than calculated BMI would demonstrate. LEVEL OF EVIDENCE 3.
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Guo Y, Zou Z, Jia L, Huang Z, Yun X, Xing G. Safety and effectiveness of argatroban versus heparin for preventing venous thromboembolism after lumbar decompressive surgery. Int J Surg 2017; 44:324-328. [PMID: 28694001 DOI: 10.1016/j.ijsu.2017.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND To evaluate the safety and effectiveness of argatroban for the prevention of venous thromboembolism (VTE) after posterior lumbar decompressive surgery. METHODS Included in this retrospective study were 556 patients who underwent posterior lumbar decompressive surgery for trauma and degenerative diseases. They were divided into two groups: argatroban group (n = 274), and low molecular weight heparin (LMWH) group (n = 282). The occurrence of postoperative venous thrombosis and complications including hemorrhage and allergic reaction was compared between the two groups. Neurological and clinical outcomes in terms of Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were assessed before operation and at 6 and 12 months after operation. RESULTS Postoperative venous thromboembolism (VTE) occurred in seven patient. No pulmonary embolism (PE) occurred in any patient. Thrombosis occurred in 3 cases (1.0%) and bleeding in 1 case (0.04%) in argatroban group vs. 4 (1.4%) and 4 (1.4%) in LMWH group, showing no significant between the two groups (P > 0.05). There was significant reduction in the severity of back and leg pain (VAS P < 0.05) and significant improvement in the patient quality of life (ODI, P < 0.05) 6 months and 1 year after operation, showing no significant difference between the two groups (P > 0.05). CONCLUSIONS Argatroban proved to be equally effective as LWMH for anticoagulation therapy. Both drugs exhibited a similar preventive effect against postoperative VTE after posterior lumbar spine surgery, without increasing the risk of postoperative bleeding. The neurological and clinical outcomes are satisfactory and similar between the two pharmacological methods.
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Affiliation(s)
- Ying Guo
- Department of Spine Surgery, Changzheng Hospital of Second Military Medical University, Shanghai, PR China; Department of Orthopedic Surgery, NO.187 Hospital of CPLA, Haikou, Hainan, PR China
| | - Zhongwen Zou
- Department of Orthopedic Surgery, NO.187 Hospital of CPLA, Haikou, Hainan, PR China
| | - Lianshun Jia
- Department of Spine Surgery, Changzheng Hospital of Second Military Medical University, Shanghai, PR China.
| | - Zhi Huang
- Department of Orthopedic Surgery, NO.187 Hospital of CPLA, Haikou, Hainan, PR China
| | - Xiong Yun
- Department of Orthopedic Surgery, NO.187 Hospital of CPLA, Haikou, Hainan, PR China
| | - Guo Xing
- Department of Orthopedic Surgery, NO.187 Hospital of CPLA, Haikou, Hainan, PR China
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