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
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]