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Pulmonary Embolism After Adult Spinal Deformity Surgery

Pateder, Dhruv B. MD*; Gonzales, Ricardo A. MD; Kebaish, Khaled M. MD; Antezana, David F. MD; Cohen, David B. MD, MPH; Chang, Jen-Yi MD; Kostuik, John P. MD

doi: 10.1097/BRS.0b013e31816245e1

Study Design. Retrospective review.

Objective. To determine the incidence and identify the associated risk factors of pulmonary embolism (PE) in patients who receive pharmacologic thromboprophylaxis after adult spinal deformity surgery.

Summary of Background Data. The risk of PE after adult spinal deformity surgery is reported to be as high as 2.2%. However, the incidence and associated risks of PE in the same patient population who receive postoperative pharmacologic thromboprophylaxis is unknown.

Methods. The study included 361 adult patients with spinal deformity who underwent 407 corrective spinal procedures for scoliosis, kyphosis, or kyphoscoliosis. The incidence of PE was determined and compared with a study (historical control) of similar patients undergoing similar surgery but without postoperative pharmacologic thromboprophylaxis. Their demographic information, American Society of Anesthesiologists score, operative time, surgical approach, surgical complexity, and intraoperative blood loss were also analyzed to determine the presence of associated risk factors.

Results. Despite universal pharmacologic thromboprophylaxis, 10 pulmonary emboli (2.4%) were diagnosed. Patients undergoing anterior spinal surgery were at a significantly higher risk than those undergoing posterior spinal surgery (P = 0.024). The right-side anterior approach was also associated with a significantly higher incidence of PE compared with the left-sided anterior approach (P = 0.018). Although the rate of PE after posterior spinal surgery did not differ from the historical control, the rate of PE after anterior surgery was reduced by 50% compared with the historical control. Age, gender, estimated blood loss, operative time, revision status, and the number of fusion levels were not significant variables for PE. There were 2 epidural hematomas requiring decompression (0.48%) and 1 wound hematoma (0.24%).

Conclusion. Although pharmacologic thromboprophylaxis probably does not have a role after posterior spinal surgery, the data in this study suggest that it does lower the incidence of PE after anterior spinal surgery.

Compared with a similar study where patients did not receive pharmacologic thromboprophylaxis, the current study demonstrated that postoperative pharmacologic thromboprophylaxis reduced the rate of PE by 50% in patients undergoing anterior spinal surgery; however, the rate of PE after posterior spinal surgery did not differ between the two studies. The data suggest that pharmacologic thromboprophylaxis probably does have a role after anterior spinal surgery but not after posterior spinal surgery.

From the *Steadman Hawkins Clinic Spine Surgery, Frisco/Vail, CO; and ‡Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD.

Acknowledgment date: July 3, 2007. Revision date: August 6, 2007. Acceptance date: August 8, 2007.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Dhruv B. Pateder, MD, Steadman Hawkins Spine Surgery Vail/Frisco, 181 W. Meadow Dr, Suite 400, Vail, CO 81657; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.