Fatal pulmonary fat embolism following spinal fusion surgery

Stroud, Michael H.; McCarthy, R.; Parham, David M.; Schexnayder, Stephen M.

doi:10.1097/01.pcc.0000216422.29357.16

Cited by 13 publications

(13 citation statements)

References 20 publications

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“…The mechanism of pulmonary complication following spinal surgery may be related to direct lung tissue trauma, embolization of marrow material into the lung, including fat, ventilation-associated lung injury, and transfusion-associated lung injury. 19 - 22 …”

Section: Introductionmentioning

confidence: 99%

Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa

Wulff¹,

Duah²,

Tutu³

et al. 2020

Global Spine Journal

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Study Design: Retrospective review of consecutive series. Objectives: This study sought to assess the incidence, risk factors, and outcomes of pulmonary complication following complex spine deformity surgery in a low-resourced setting in West Africa. Methods: Data of 276 complex spine deformity patients aged 3 to 25 years who were treated consecutively was retrospectively reviewed. Patients were categorized into 2 groups during data analysis based on pulmonary complication status: group 1: yes versus group 2: no. Comparative descriptive and inferential analysis were performed to compare the 2 groups. Results: The incidence of pulmonary complication was 17/276 (6.1%) in group 1. A total of 259 patients had no events (group 2). There were 8 males and 9 females in group 1 versus 100 males and 159 females in group 2. Body mass index was similar in both groups (17.2 vs 18.4 kg/m2, P = .15). Average values (group 1 vs group 2, respectively) were as follows: preoperative sagittal Cobb angle (90.6° vs 88.7°, P = .87.), coronal Cobb angle (95° vs 88.5°, P = .43), preoperative forced vital capacity (45.3% vs 62.0%, P = .02), preoperative FEV1 (forced expiratory volume in 1 second) (41.9% vs 63.1%, P < .001). Estimated blood loss, operating room time, and surgery levels were similar in both groups. Thoracoplasty and spinal osteotomies were performed at similar rates in both groups, except for Smith-Peterson osteotomy. Multivariate logistic regression showed that every unit increase in preoperative FEV1 (%) decreases the odds of pulmonary complication by 9% (OR = 0.91, 95% CI 0.84-0.98, P = .013). Conclusion: The observed 6.1% incidence of pulmonary complications is comparable to reported series. Preoperative FEV1 was an independent predictor of pulmonary complications. The observed case fatality rate following pulmonary complications (17%) highlights the complexity of cases in underserved regions and the need for thorough preoperative evaluation to identify high-risk patients.

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Section: Introductionmentioning

confidence: 99%

Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa

Wulff¹,

Duah²,

Tutu³

et al. 2020

Global Spine Journal

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“…In the last 50 years, only eight single reports of fatal Fat Embolism Syndrome related with spine surgery (with and without instrumentation) were reported and un-derestimation of the phenomenon need to be considered in surgical practice (Table 3) [32][33][34][35][36][37][38][39].…”

Section: Discussionmentioning

confidence: 99%

Spine surgery and fat embolism syndrome. Defining the boundaries of medical accountability by hospital autopsy

Radaelli¹,

Zanon²,

Concato³

et al. 2021

Front. Biosci. (Landmark Ed)

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Background: Fat Embolism Syndrome (FES) is a clinical condition characterized by neurological, respiratory, hematological and cutaneous manifestations. Fatal FES has been described as a rare complication during or after spinal elective surgery. The investigation of the cause of death in fatalities related with spine surgery should be mandatory to exclude or confirm fat embolism; a detailed methodological approach to the body in these cases suggests to provide a cautious dissection of surgical site and collection of samples to detect embolized fat globules in vessels. Methods: Two fatal cases of fat embolism syndrome after posterior spinal fusion are presented. Conclusions: A complete post mortem examination by means of histochemical and immunohistochemical analysis explained the cause of death and prevented medical malpractice litigation. Fineschi V. CD61 and fibrinogen immunohistochemical study to improve the post-mortem diagnosis in a fat embolism syndrome clinically demonstrated by transesophageal echocardiography. Forensic Science International. 2010; 202: e13-e17.

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“…For instance, the report of sole clinical manifestation of fat laden macrophages in the bronchoalveolar lavage of a patient with hypoxaemia, which was a non-specific symptom frequently present after any long bone fracture 15. In addition, there were also reports of FES following spinal arthrodesis and augmentation of spine pedicle screws with bone cement resulting in fulminating pulmonary fat embolism 1–3. There were also reports of isolated cerebral fat emboli syndrome with subtle clinical signs and were diagnosed by MRI and CT changes 16.…”

Section: Discussionmentioning

confidence: 99%

“…Postulations for this variation could be due to the difference in marrow composition as the proportion of haematopoietic tissue to fat in a child’s bone marrow is more than that found in adults 1. Thus, there are only case reports of this condition in paediatric patients which mainly involve spinal fusion or screw augmentations 1–3.…”

Section: Introductionmentioning

confidence: 99%

Fat embolism syndrome in a child with dystonia musculorum deformans

Ng¹,

Chow²,

To³

2012

Case Reports

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A 16-year-old boy with dystonia musculorum deformans underwent an operation for removal of femoral implants and excision of the prominence at the greater trochanter of the left hip. He was found to have fat embolism syndrome at postoperative day 1 as evidenced by confusion, respiratory symptoms, chest radiograph changes, raised erythrocyte sedimentation rate, thrombocytopenia and fat in the urine and sputum.

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Fatal pulmonary fat embolism following spinal fusion surgery

Cited by 13 publications

References 20 publications

Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa

Postoperative Pulmonary Complications in Complex Pediatric and Adult Spine Deformity: A Retrospective Review of Consecutive Patients Treated at a Single Site in West Africa

Spine surgery and fat embolism syndrome. Defining the boundaries of medical accountability by hospital autopsy

Fat embolism syndrome in a child with dystonia musculorum deformans

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