Preoperative deep vein thrombosis in patients with cervical spondylotic myelopathy scheduled for spinal surgery

Liu, Le; Liu, Yanbin; Sun, Jianmin; Hou, Haifeng; Liang, Changhong; Li, Tao; Qi, Hengtao

doi:10.1097/md.0000000000005269

Cited by 10 publications

(8 citation statements)

References 16 publications

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Section: Discussionsupporting

confidence: 91%

“…If the level exceeds the reference value, we perform DVT screening by ultrasonography. Previous studies that assessed the incidence of preoperative DVT in patients with degenerative musculoskeletal disorders focused on patients undergoing a single type of surgery, including TKA, THA, or spinal surgery [8][9][10][11][12][13][14][15][16]. To the best of our knowledge, few single cross-sectional studies have considered all these surgeries in the assessment of the preoperative prevalence of DVT.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Sato

Date

Michikawa

et al. 2021

Preprint

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Background: Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for musculoskeletal degenerative disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT.Methods: The clinical data of patients aged ≥30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 μg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography.Results: Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 μg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4%. One patient (0.08%) had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥80 years (odds ratio [OR], 95% confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence.Conclusions: This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Sato

Date

Michikawa

et al. 2021

Preprint

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“…Therefore, although the frequency of elective surgeries for degenerative spinal disorders is low, preventing VTE is observed to be important, as well as performing TKA and THA. According to Liu et al, the incidence of preoperative DVT in patients with cervical spondylotic myelopathy scheduled for spinal surgery was 4 %, which is similar to the results of this study [ 15 ]. Meanwhile, Yamasaki et al found that the incidence of preoperative DVT in elective lumbar spine surgeries was 7.7 % when the vertebral body fracture group was excluded [ 16 ], which is also similar to the lumbar surgery data from the present study.…”

Section: Discussionsupporting

confidence: 91%

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

Sato

Date

Michikawa

et al. 2021

BMC Musculoskelet Disord

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Background Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for degenerative musculoskeletal disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT. Methods The clinical data of patients aged ≥ 30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 µg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography. Results Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 µg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4 %. No patient had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥ 80 years (odds ratio [OR], 95 % confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence. Conclusions This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

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“…Five articles recommended preoperative and/or postoperative routine screening for DVT. Liu et al, investigated routine DVT screening in a retrospective cross-sectional study 40 . Of 396 patients with CSM, 16 (4%) had preoperative DVT.…”

Section: - Is Routine Screening For Dvt Required In the Pre-operative...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Spine

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Spine Delegates* 1 -Is routine screening for DVT required in the preoperative and/or post-operative period for patients undergoing spine procedures?Response/Recommendation: There is no role for routine screening for deep venous thrombosis (DVT) in patients undergoing spine procedures. Doppler ultrasonography surveillance may be considered in high-risk surgical patients including those who are older, with spine injury, personal history of VTE, malignancy, cervical spondylotic myelopathy (CSM), and/or non-ambulatory.Strength of Recommendation: Limited.Delegates vote: Agree 96.43% Disagree 3.57% Abstain 0.00% (Strong Consensus).Rationale: Venous thromboembolism (VTE) is a wellknown complication of major orthopaedic and spine surgeries. The reported incidence of VTE in patients undergoing spine surgery range from 0.29% -31% 1-3 . Moreover, the overall rates of pulmonary (PE) and associated fatality after spinal surgery are 1.38% and 0.34%, respectively [2][3][4][5] .Although contrast venography has been used for diagnosis of DVT, it is not suitable for the routine screening of asymptomatic patients due to potential complications, technical issues, expense, and invasiveness 6 . Similarly, the use of D-dimer, a byproduct of fibrinolysis 7 , as a screening tool lacked sensitivity and specificity in detecting VTE after hip arthroplasty [8][9][10][11][12] . Ultrasonography, on the other hand, has become the primary non-invasive method for investigating suspected DVT of the femoral and popliteal veins 9 . Standard ultrasound showed relatively high sensitivity (> 90%) for proximal or (around 60%) for below-the-knee DVT in a systematic review of diagnostic cohort studies 13 . Duplex ultrasonography (DUS) has also improved precision and efficiency in diagnosing DVT compared to most non-invasive techniques 14 . Furthermore, combined D-dimer and ultrasound screening in patients with acute spinal cord injury have improved the detection of VTE compared to D-dimer screening alone 15 .However, controversy remains regarding the use of routine screening for DVT in the perioperative period for patients undergoing spine procedures. We performed an extensive systematic review of all publications. A total of 26 articles that satisfied all inclusion criteria were selected for data extraction after full review. Information about these studies with respect to year of publication, level of evidence, number of patients, methods of screening, timing of screening, methods of prophylaxis, and incidence of VTE are summarized in Table I. Studies suggest against screening for patients undergoing spine surgery while others recognize that only patients at high risk may benefit. Based on the available literature, the risk factors for an increased risk of VTE in patients undergoing spine surgery may be seen in older patients, long periods of bedrest from paralysis and pain, high D-dimer level, longer duration of operation, intraoperative blood loss and transfusion, previous history of VTE, fracture, comorbid disease burden and tumor surgery...

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Preoperative deep vein thrombosis in patients with cervical spondylotic myelopathy scheduled for spinal surgery

Cited by 10 publications

References 16 publications

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Preoperative prevalence of deep vein thrombosis in patients with musculoskeletal degenerative disorders

Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

Recommendations from the ICM-VTE: Spine

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