Predictable Risk Factors of Spontaneous Venous Thromboembolism in Patients Undergoing Spine Surgery

Xin, Wenqiang; Xin, Qi-qiang; Ming, Haolang; Gao, Yalong; Zhao, Yan; Gao, Yikuan; Yang, Xinyu

doi:10.1016/j.wneu.2019.04.126

Cited by 20 publications

(20 citation statements)

References 45 publications

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“…Therefore, accurately identifying the risk factors of VTE helps clinicians adjust clinical decisions in a timely manner to adapt to the different conditions of patients. For non-tumor spinal surgery, there have been some studies that discussed the incidence and risk factors of VTE in detail ( 7 , 8 , 25 ), and a predictive score had been established ( 6 ). However, for spinal metastasis surgery, the current research results are far from enough.…”

Section: Discussionmentioning

confidence: 99%

“…For the risk factors of VTE after spinal surgery, some studies have reported the corresponding results, and some risk scores have been established ( 6 – 8 ). However, it is still unclear whether these conclusions are equally applicable to spinal metastasis surgery, because the treatment measures and prognostic characteristics of patients with spinal metastases are very specific ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Nomogram for Predicting the Postoperative Venous Thromboembolism in Spinal Metastasis Tumor: A Multicenter Retrospective Study

Zhang

Yang

et al. 2021

Front. Oncol.

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IntroductionVenous thromboembolism can be divided into deep vein thrombosis and pulmonary embolism. These diseases are a major factor affecting the clinical prognosis of patients and can lead to the death of these patients. Unfortunately, the literature on the risk factors of venous thromboembolism after surgery for spine metastatic bone lesions are rare, and no predictive model has been established.MethodsWe retrospectively analyzed 411 cancer patients who underwent metastatic spinal tumor surgery at our institution between 2009 and 2019. The outcome variable of the current study is venous thromboembolism that occurred within 90 days of surgery. In order to identify the risk factors for venous thromboembolism, a univariate logistic regression analysis was performed first, and then variables significant at the P value less than 0.2 were included in a multivariate logistic regression analysis. Finally, a nomogram model was established using the independent risk factors.ResultsIn the multivariate logistic regression model, four independent risk factors for venous thromboembolism were further screened out, including preoperative Frankel score (OR=2.68, 95% CI 1.78-4.04, P=0.001), blood transfusion (OR=3.11, 95% CI 1.61-6.02, P=0.041), Charlson comorbidity index (OR=2.01, 95% CI 1.27-3.17, P=0.013; OR=2.29, 95% CI 1.25-4.20, P=0.017), and operative time (OR=1.36, 95% CI 1.14-1.63, P=0.001). On the basis of the four independent influencing factors screened out by multivariate logistic regression model, a nomogram prediction model was established. Both training sample and validation sample showed that the predicted probability of the nomogram had a strong correlation with the actual situation.ConclusionThe prediction model for postoperative VTE developed by our team provides clinicians with a simple method that can be used to calculate the VTE risk of patients at the bedside, and can help clinicians make evidence-based judgments on when to use intervention measures. In clinical practice, the simplicity of this predictive model has great practical value.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nomogram for Predicting the Postoperative Venous Thromboembolism in Spinal Metastasis Tumor: A Multicenter Retrospective Study

Zhang

Yang

et al. 2021

Front. Oncol.

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“…Two meta-analyses 399,400 evaluating the relationship between blood loss and postoperative VTE in spine surgery have presented contradictory findings. While Xin et al, identified blood loss to be associated with VTE risk among patients undergoing spine surgery, the majority of included studies primarily conducted univariate analyses without adjusting for confounding factors 400 .…”

Section: - Does the Volume Of Intraoperative Blood Loss Influence The...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…Common risk factors for VTE after elective spine surgery include increasing age, 18 , 29 , 30 coagulopathy, 31 malignancy, 30 hypertension, 32 reduced mobility or functional disability, 33 - 35 and surgical factors, including length of surgery and blood loss. 18 , 36 - 38 Hohl et al 9 report a significant increase in symptomatic PEs (3%) in patients who underwent fusions of 5 or more segments.…”

Section: Discussionmentioning

confidence: 99%

Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

Fourman

Shaw

Nwasike

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: To assess the impact of fondaparinux on venous thromboembolism (VTE) following elective lumbar spine surgery in high-risk patients. Methods: Matched patient cohorts who did or did not receive inpatient fondaparinux starting postoperative day 2 following elective lumbar spine surgery were compared. All patients received 1 month of acetyl salicylic acid 325 mg following discharge. The primary outcome was a symptomatic DVT (deep vein thrombosis) or PE (pulmonary embolus) within 30 days of surgery. Secondary outcomes included prolonged wound drainage, epidural hematoma, and transfusion. Results: A significantly higher number of DVTs were diagnosed in the group that did not receive inpatient VTE prophylaxis (3/102, 2.9%) compared with the fondaparinux group (0/275, 0%, P = .02). Increased wound drainage was seen in 18.5% of patients administered fondaparinux, compared with 25.5% of untreated patients ( P = .15). Deep infections were equivalent (2.2% with fondaparinux vs 4.9% control, P = .18). No epidural hematomas were noted, and the number of transfusions after postoperative day 2 and 90-day return to operating room rates were equivalent. Conclusions: Patients receiving fondaparinux had lower rates of symptomatic DVT and PE and a favorable complication profile when compared with matched controls. The retrospective nature of this work limits the safety and efficacy claims that can be made about the use of fondaparinux to prevent VTE in elective lumbar spine surgery patients. Importantly, this work highlights the potential safety of this regimen, permitting future high-quality trials.

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Predictable Risk Factors of Spontaneous Venous Thromboembolism in Patients Undergoing Spine Surgery

Cited by 20 publications

References 45 publications

Nomogram for Predicting the Postoperative Venous Thromboembolism in Spinal Metastasis Tumor: A Multicenter Retrospective Study

Nomogram for Predicting the Postoperative Venous Thromboembolism in Spinal Metastasis Tumor: A Multicenter Retrospective Study

Recommendations from the ICM-VTE: General

Use of Fondaparinux Following Elective Lumbar Spine Surgery Is Associated With a Reduction in Symptomatic Venous Thromboembolism

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