The Incidence and Mortality of Thromboembolic Events in Lumbar Spine Surgery.

By London Spine
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The Incidence and Mortality of Thromboembolic Events in Lumbar Spine Surgery.

Spine (Phila Pa 1976). 2013 Jan 15;

Authors: Fineberg SJ, Oglesby M, Patel AA, Pelton MA, Singh K

Abstract
Study Design. Retrospective database analysis.Objective. A population-based database was analyzed to identify the incidence, risk factors, and mortality associated with thromboembolic events after lumbar spine surgery.Summary of Background Data. Pulmonary embolism (PE) and deep vein thrombosis (DVT) are potential complications that may occur after orthopaedic procedures. The incidence of these complications is not well characterized after lumbar spine surgery.Methods. Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing lumbar decompression (LD), or lumbar fusion (LF) for degenerative etiologies were identified. Acute PE and DVT incidences and mortality rates were calculated. Co-morbidities were calculated using a modified Charlson Co-morbidity Index (CCI). Statistical analysis was performed using Student T-test for discrete variables and χ-test for categorical data. Logistic regression was used to identify independent predictors of thromboembolic events. A p-value of <0.0005 was used to denote statistical significance.Results. A total 578,457 LDs and LFs were identified from 2002-2009. DVT incidences were 2.4 and 4.3 per 1,000 cases in the LD and LF groups, respectively. PE incidences were 1.0 and 2.6 per 1,000 cases in the LD and LF groups, respectively. LF patients with thromboembolic events were younger, had fewer co-morbidities, and incurred greater costs than LD patients. Statistically significant predictors of DVT were pulmonary circulation disorders, coagulopathy, fluid/electrolyte disorders, anemia, obesity, teaching hospital status, and larger hospitals. Predictors for the development of a PE were pulmonary circulation disorders, fluid/electrolyte disorders, anemia, African-American ethnicity and teaching hospitals status.Conclusion. Patients undergoing LD or LF are at inherent risk of thromboembolic events. DVT and PE are more common after LF procedures. Pre-operative pulmonary circulation disorders, fluid/electrolyte disorders, deficiency anemia, and teaching hospital status were significant risk factors for both DVT and PE. Preventive measures in patients at risk may decrease the incidence of thromboembolic events.

PMID: 23324940 [PubMed – as supplied by publisher]

Long-term mortality following fractures at different skeletal sites: a population-based cohort study.

By London Spine
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Long-term mortality following fractures at different skeletal sites: a population-based cohort study.

Osteoporos Int. 2012 Dec 5;

Authors: Melton LJ, Achenbach SJ, Atkinson EJ, Therneau TM, Amin S

Abstract
Adjusting for age, sex, and precipitating cause, the relative risk of death was increased following fractures at most skeletal sites. INTRODUCTION: This study aims to determine long-term survival following fractures due to any cause at each skeletal site. METHODS: In a historical cohort study, 2,901 Olmsted County, MN, USA, residents ≥35 years old who experienced any fracture in 1989-1991 were followed passively for up to 22 years for death from any cause. Standardized mortality ratios (SMRs) compared observed to expected deaths. RESULTS: During 38,818 person-years of follow-up, 1,420 deaths were observed when 1,191 were expected (SMR, 1.2; 95 % CI, 1.1-1.3). The overall SMR was greatest soon after fracture, especially among the men, but remained elevated for over a decade thereafter. Adjusting for age and sex, relative death rates were greater for pathological fractures and less for severe trauma fractures compared to the fractures due to no more than moderate trauma. In the latter group, long-term mortality was increased following fractures at many skeletal sites. After further adjustment for precipitating cause, overall SMRs were elevated not only following fractures at the traditional major osteoporotic sites (i.e., distal forearm, proximal humerus, thoracic/lumbar vertebrae, and proximal femur) combined (SMR, 1.2; 95 % CI, 1.1-1.3) but also following all other fracture types combined (SMR 1.2; 95 % CI, 1.1-1.4), excluding the hand and foot fractures not associated with any increased mortality. CONCLUSIONS: The persistence of increased mortality long after the occurrence of a fracture has generally been attributed to underlying comorbidity, but this needs to be defined in much greater detail if specific opportunities are to be identified for reducing the excess deaths observed.

PMID: 23212281 [PubMed – as supplied by publisher]