Ian A Buchanan1, Michelle Lin2, Daniel A Donoho2, Li Ding3, Steven L Giannotta2, Frank Attenello2, William J Mack2, John C Liu2. 1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. Electronic address: ianbuchanan07@gmail.com. 2. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. 3. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Abstract
BACKGROUND: Venous thromboembolism (VTE) is an appreciable burden on health care. The protracted recumbency experienced by many spinal patients juxtaposed with concerns for postoperative hemorrhage from early anticoagulation results in conflicting stances regarding chemoprophylaxis. Identifying risk factors associated with VTE is therefore instrumental in guiding management. OBJECTIVE: To identify VTE risk factors in patients undergoing degenerative spine surgery. METHODS: The Nationwide Readmissions Database was searched for adults undergoing spine surgery for degenerative diseases between 2010 and 2014. The 30-day and 90-day VTE incidence was estimated from readmissions with new VTE diagnoses. A multivariate survey-adjusted logistic regression model was used to identify variables associated with VTE diagnoses on readmission. RESULTS: Of 838,507 degenerative spine cases queried, 3499 patients (0.42%) were readmitted with a VTE diagnosis within 30 days and 4321 patients (0.62%) were readmitted within 90 days. In multivariate analysis, steroids were independently associated with a higher likelihood of readmission with VTE at both 30 days (odds ratio, 1.58; P < 0.001) and 90 days (odds ratio, 1.97; P < 0.001). Significant associations were also identified with thoracolumbar surgery, length of stay, and discharge to institutional care. CONCLUSIONS: The incidence of readmission with VTE diagnoses in spine surgery is low. However, their devastating consequences underscore the need to identify those patients deemed high risk. These patients include those having thoracolumbar surgery, of advanced age, with prolonged length of stay, using corticosteroids, and with a disposition to institutional care (e.g., skilled nursing facility or long-term acute care). Given the association between steroids and VTE, clinicians should be judicious about perioperative administration despite their obvious antiinflammatory benefits.
BACKGROUND:Venous thromboembolism (VTE) is an appreciable burden on health care. The protracted recumbency experienced by many spinal patients juxtaposed with concerns for postoperative hemorrhage from early anticoagulation results in conflicting stances regarding chemoprophylaxis. Identifying risk factors associated with VTE is therefore instrumental in guiding management. OBJECTIVE: To identify VTE risk factors in patients undergoing degenerative spine surgery. METHODS: The Nationwide Readmissions Database was searched for adults undergoing spine surgery for degenerative diseases between 2010 and 2014. The 30-day and 90-day VTE incidence was estimated from readmissions with new VTE diagnoses. A multivariate survey-adjusted logistic regression model was used to identify variables associated with VTE diagnoses on readmission. RESULTS: Of 838,507 degenerative spine cases queried, 3499 patients (0.42%) were readmitted with a VTE diagnosis within 30 days and 4321 patients (0.62%) were readmitted within 90 days. In multivariate analysis, steroids were independently associated with a higher likelihood of readmission with VTE at both 30 days (odds ratio, 1.58; P < 0.001) and 90 days (odds ratio, 1.97; P < 0.001). Significant associations were also identified with thoracolumbar surgery, length of stay, and discharge to institutional care. CONCLUSIONS: The incidence of readmission with VTE diagnoses in spine surgery is low. However, their devastating consequences underscore the need to identify those patients deemed high risk. These patients include those having thoracolumbar surgery, of advanced age, with prolonged length of stay, using corticosteroids, and with a disposition to institutional care (e.g., skilled nursing facility or long-term acute care). Given the association between steroids and VTE, clinicians should be judicious about perioperative administration despite their obvious antiinflammatory benefits.
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