Charla R Fischer 1 , Erik Wang 1 , Leah Steinmetz 1 , Dennis Vasquez-Montes 1 , Aaron Buckland 1 , John Bendo 1 , Anthony Frempong-Boadu 1 , Thomas Errico 1 Show Affiliations »
Abstract
BACKGROUND: Hospital-acquired venous thromboembolisms (HA-VTE) are a significant source of morbidity and mortality in spine surgery patients. The purpose of this study was to review HA-VTE rates at our institution and evaluate the prevalence of known risk factors in patients who developed HA-VTE among both neurosurgical and orthopedic spine surgeries. METHODS: Retrospective chart reviews were conducted of all spine surgery patients from January 1, 2013, to July 31, 2017, to evaluate rates of HA-VTE and prevalence of known HA-VTE risk factors among these patients. Univariate and multivariate logistic regression analysis for categorical variables and independent Student t test for continuous variables were utilized with significance set at P < .05. RESULTS: The overall HA-VTE rate was 0.94% (0.61% orthopedic, 1.87% neurosurgery). Patients with VTEs had higher rates of thoracic procedure (P = .002), posterior approach (P = .001), diagnosis of fracture (P = .013) or flatback syndrome (P = .028), neurosurgery division (P < .001), and diagnosis-related group (DRG) of noncervical malignancy (P = .001). Patients with VTEs had lower rates of cervical procedure (P < .001), diagnosis of herniated nucleus pulposus (P = .006) and degenerative disc disease (P = .001), and DRG of cervical spine fusion (P < .001). In the patients who sustained VTE, the neurosurgical patients had higher rates of active cancer (22.86% vs 0%, P = .004) and age >60 (80% vs 50%, P < .001), and orthopedic patients had higher estimated blood loss (EBL) (2436 ml vs 1176 mL, P = .006) and rates of anterior-posterior surgery (22.58% vs 0%, P = .003). Neurosurgery department, diagnosis of fracture, and DRG of noncervical malignancy were found to be significant independent risks for developing HA-VTE. Cervical procedures were independently associated with significantly lower risk. Postoperative anticoagulation initiated sooner in neurosurgery patients (postoperative day 1.26 vs 3.19, P < .001). CONCLUSIONS: The overall HA-VTE rate at our institution was 0.94% (0.61% orthopedic, 1.87% neurosurgery). In patients who sustained VTE, neurosurgical patients had higher rates of active cancer and age >60 years, and orthopedic patients had higher EBL and rates of anterior-posterior surgery. This highlights the different patient populations between the 2 departments and the need for individualized thromboprophylaxis regimens. LEVEL OF EVIDENCE: 4. ©International Society for the Advancement of Spine Surgery 2020.
BACKGROUND: Hospital-acquired venous thromboembolisms (HA-VTE) are a significant source of morbidity and mortality in spine surgery patients. The purpose of this study was to review HA-VTE rates at our institution and evaluate the prevalence of known risk factors in patients who developed HA-VTE among both neurosurgical and orthopedic spine surgeries. METHODS: Retrospective chart reviews were conducted of all spine surgery patients from January 1, 2013, to July 31, 2017, to evaluate rates of HA-VTE and prevalence of known HA-VTE risk factors among these patients. Univariate and multivariate logistic regression analysis for categorical variables and independent Student t test for continuous variables were utilized with significance set at P < .05. RESULTS: The overall HA-VTE rate was 0.94% (0.61% orthopedic, 1.87% neurosurgery). Patients with VTEs had higher rates of thoracic procedure (P = .002), posterior approach (P = .001), diagnosis of fracture (P = .013) or flatback syndrome (P = .028), neurosurgery division (P < .001), and diagnosis-related group (DRG) of noncervical malignancy (P = .001). Patients with VTEs had lower rates of cervical procedure (P < .001), diagnosis of herniated nucleus pulposus (P = .006) and degenerative disc disease (P = .001), and DRG of cervical spine fusion (P < .001). In the patients who sustained VTE, the neurosurgical patients had higher rates of active cancer (22.86% vs 0%, P = .004) and age >60 (80% vs 50%, P < .001), and orthopedic patients had higher estimated blood loss (EBL) (2436 ml vs 1176 mL, P = .006) and rates of anterior-posterior surgery (22.58% vs 0%, P = .003). Neurosurgery department, diagnosis of fracture, and DRG of noncervical malignancy were found to be significant independent risks for developing HA-VTE. Cervical procedures were independently associated with significantly lower risk. Postoperative anticoagulation initiated sooner in neurosurgery patients (postoperative day 1.26 vs 3.19, P < .001). CONCLUSIONS: The overall HA-VTE rate at our institution was 0.94% (0.61% orthopedic, 1.87% neurosurgery). In patients who sustained VTE, neurosurgical patients had higher rates of active cancer and age >60 years, and orthopedic patients had higher EBL and rates of anterior-posterior surgery. This highlights the different patient populations between the 2 departments and the need for individualized thromboprophylaxis regimens. LEVEL OF EVIDENCE: 4. ©International Society for the Advancement of Spine Surgery 2020.
Entities: Chemical
Keywords:
hospital acquired; prevention; venous thromboembolism
Year: 2020
PMID： 32128307 PMCID： PMC7043815 DOI： 10.14444/7011
Source DB: PubMed Journal: Int J Spine Surg ISSN： 2211-4599