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Patient-Based and Surgical Characteristics Associated With the Acute Development of Deep Venous Thrombosis and Pulmonary Embolism After Spine Surgery

Schoenfeld, Andrew J. MD*; Herzog, Joshua P. MD*; Dunn, John C. MD*; Bader, Julia O. PhD; Belmont, Philip J. Jr MD*

Spine:
doi: 10.1097/BRS.0b013e31829fc3a0
Surgery
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Abstract

Study Design. Retrospective analysis of a prospectively collected data set.

Objective. Identify the incidence of, and risk factors for, deep venous thrombosis (DVT) and pulmonary embolism (PE) after spine surgery.

Summary of Background Data. Determination of ideal candidates for chemoprophylaxis after spine surgery is limited by the state of the literature, including incomplete understanding regarding the incidence of DVT and PE, as well as an inability to quantify specific risk factors among patients.

Methods. The 2005 to 2011 data set of the National Surgical Quality Improvement Program was queried to identify all individuals having undergone spine surgery. Demographic data, medical comorbidities, surgical characteristics, and the presence of DVT, PE, and/or mortality were abstracted for all individuals meeting inclusion criteria. Unadjusted univariate analysis was performed to identify variables that were potentially associated with the development of DVT or PE after surgery. A multivariate logistic regression test, controlling for other factors present in the model, was subsequently performed. Predictor variables that maintained significance after multivariate testing were considered influential in the development of DVT and/or PE.

Results. There were 27,730 patients who received spine procedures in this cohort. The average age was 56.4 (±15.1) years. Lumbar spine procedures made up 61% of interventions. Death occurred in 87 instances (0.3%). The venous thromboembolic rate was 1%, with 206 individuals (0.7%) sustaining DVT and 113 (0.4%) developing a PE. Body mass index 40 and greater, age 80 years and older, operative time exceeding 261 minutes, and American Society of Anesthesiologists classification 3 or higher were identified as significant independent predictors of DVT, whereas body mass index 40 and greater, operative time exceeding 261 minutes, and male sex were associated with the development of PE.

Conclusion. Multiple independent risk factors for the development of DVT and/or PE after spine surgery were identified. Patients with these characteristics may require additional counseling, procedural modification, or prophylaxis against venous thromboembolic events.

Level of Evidence: 2

In Brief

The 2005 to 2011 data set of the National Surgical Quality Improvement program was used to identify specific risk factors for the development of deep venous thrombosis or pulmonary embolism after spine surgery. Significant predictor variables included body mass index 40 and greater, age 80 years and older, extensive operative time, male sex, and American Society of Anesthesiologists classification 3 or higher.

Author Information

*Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX; and

Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX.

Address correspondence and reprint requests to Andrew J. Schoenfeld, MD, Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras St, El Paso, TX 79920; E-mail: ajschoen@neomed.edu

Acknowledgment date: February 14, 2013. Revision date: May 3, 2013. Acceptance date: June 6, 2013.

Some authors are employees of the U.S. Federal Government and the United States Army. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of William Beaumont Army Medical Center, the Department of Defense, or United States government.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: royalties.

© 2013 by Lippincott Williams & Wilkins