Risk Factors for Venous Thromboembolism After Spine Surgery

Tominaga, Hiroyuki; Setoguchi, Takao; Tanabe, Fumito; Kawamura, Ichiro; Tsuneyoshi, Yasuhiro; Kawabata, Naoyuki; Nagano, Satoshi; Abematsu, Masahiko; Yamamoto, Takuya; Yone, Kazunori; Komiya, Setsuro

doi:10.1097/md.0000000000000466

Cited by 65 publications

(73 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In adult total hip and knee arthroplasty, the rate of predischarge symptomatic VTE approaches 2% even after thromboprophylaxis, although many more VTEs occur postdischarge and are asymptomatic. 17 In adult spine surgery, symptomatic VTE occurs in 1.5% of patients; 18 this rate is □10 times the rate in our observed pediatric spine population (0.10%). Therefore, the low rate of occurrence in pediatric orthopaedic surgery patients, compared with adults, calls into question whether routine thromboprophylaxis should be indicated.…”

Section: Discussionmentioning

confidence: 67%

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

Baker

Sherrod

McGwin

et al. 2016

Journal of the American Academy of Orthopaedic Surgeons

View full text Add to dashboard Cite

Introduction The risk of morbidity associated with venous thromboembolism (VTE) after pediatric orthopaedic surgery remains unclear despite increased use of thromboprophylaxis measures. Methods The American College of Surgeons National Surgical Quality Improvement Program, Pediatric database was queried for patients undergoing an orthopaedic surgical procedure between 2012 and 2013. Upper extremity and skin/subcutaneous surgeries were excluded. Associations between VTE and procedure, demographics, comorbidities, preoperative laboratory values, and 30-day postoperative outcomes were evaluated. Results Of 14,776 cases, 15 patients (0.10%) experienced postoperative VTE. Deep vein thrombosis (DVT) occurred in 13 patients (0.09%), and pulmonary embolism developed in 2 patients (0.01%). The procedure with the highest VTE rate was surgery for infection (1.2%). Patient factors associated with the development of VTE included hyponatremia (P = 0.003), abnormal partial thromboplastin time (P = 0.046), elevated aspartate transaminase level (P = 0.004), and gastrointestinal (P = 0.011), renal (P = 0.016), and hematologic (P = 0.019) disorders. Nearly half (46.2%) of DVTs occurred postdischarge. Complications associated with VTE included prolonged hospitalization (P = <0.001), pneumonia (P = <0.001), unplanned intubation (P = 0.003), urinary tract infection (P = 0.003), and central line-associated bloodstream infection (P = <0.001). Most of the postoperative complications (66.7%) occurred before VTE diagnosis, and no patients with VTE died. Conclusion In the absence of specified risk factors, thromboprophylaxis may be unnecessary for this population.

show abstract

Section: Discussionmentioning

confidence: 67%

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

Baker

Sherrod

McGwin

et al. 2016

Journal of the American Academy of Orthopaedic Surgeons

View full text Add to dashboard Cite

show abstract

“…Four studies [31,33–35] reported relation between history of smoking and incidence of VTE. The result showed that a history of smoking did not affect incidence of VTE ( P = 0.13, OR = 1.20, 95% CI [0.95, 1.51]; heterogeneity: P = 0.36, I 2 = 6%, fixed-effects model; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [28,31,32] reported relation between walking disability preoperation and incidence of VTE. The result showed that walking disability preoperation significantly increased the incidence of VTE ( P < 0.00001, OR = 4.80, 95% CI [2.53, 9.12]; heterogeneity: P = 0.64, I 2 = 0%, fixed-effects model; Fig.…”

Section: Resultsmentioning

confidence: 99%

Factors predicting venous thromboembolism after spine surgery

et al. 2016

View full text Add to dashboard Cite

Background:A meta-analysis was performed to explore predicted factors of venous thromboembolism (VTE) after surgery in the treatment for spine degeneration diseases.Summary of background data:Many scholars have focused on VTE after spine surgery, but as for the risk factors of VTE have not reached a consensus.Methods:An extensive search of literature, “spine or spinal,” “degeneration,” “after surgery or postoperation,” and “venous thromboembolism” as key words, was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases. The following variables were extracted: wearing elastic stocking, hypertension (HT), heart disease, diabetes, drinking, anticoagulant therapy, walking disability preoperation, smoking, sex, age, surgical duration, fusion versus nonfusion (lumbar fusion vs lumbar discectomy), surgical site (cervical vs lumbar), blood loss, and body mass index. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:A total of 12 studies were identified, including 34,597 patients of whom 624 patients had VTE, and the incidence of VTE was 2% in all patients who underwent spine surgery. The incidence of VTE for Asian patients was 7.5%, compared with 1% VTE for Occidental patients; the difference was significant (P < 0.0001). The pooled analysis showed that there were significant differences regarding wearing elastic stocking (odds ratio [OR] = 11.71, 95% confidence interval [CI] [1.46, 94.00], P = 0.02), walking disability preoperation (OR = 4.80, 95% CI [2.53, 9.12], P < 0.00001), surgical site (lumbar surgery) (OR = 0.23, 95% CI [0.20, 0.27], P < 0.00001), HT (OR = 1.59, 95% CI [1.21, 2.10], P = 0.001), and diabetes (OR = 2.12, 95% CI [1.09, 4.10], P = 0.03). However, there were no significant differences in blood loss, heart disease, smoking, sex, surgical duration, body mass index, surgical duration, anticoagulant therapy, wearing elastic stocking, fusion versus nonfusion, drinking, and age (all P > 0.05).Conclusions:Based on our meta-analysis, Asian patients, patients with walking disability preoperation, patients wearing elastic stocking, patients having undergone lumbar surgery, patients with a history of HT, and patients experiencing diabetes have a higher incidence of VTE after spine surgery.

show abstract

“…In the preoperative phase, certain high-risk modifiable risk factors, mainly insulin-dependent diabetes, smoking, and long-term steroid use, should be identified and mitigated. 80,83,125,127,141,143,159 In the intraoperative phase, attention to physiological parameters, use of neuromonitoring adjuncts, judicious use of autologous blood transfusions, and shorter surgical times all reduce the likelihood of complications. 60,155 In the postoperative phase, appropriate mechanical and chemical prophylaxis for venous thrombosis, timely removal of urinary catheters, meticulous blood glucose control, appropriate mobilization of patients, and close neurological monitoring can reduce the incidence of these events.…”

Section: Rationalementioning

confidence: 99%

“…43,87,100 Physical therapy, including gait training, has also been shown to improve mobility and reduce the incidence of complications such as DVT and PE. 143 The time frame during which these rehabilitation programs have shown to have proven efficacy span the period from immediately postoperatively with inpatient rehabilitation services to programs starting 4 to 6 weeks postsurgery. Accurate assessment of postsurgical physical therapy assignment is essential to assess the impact of these interventions, better understand overall resource utilization in spine care, and assist in the planning of continuing care.…”

Section: Rationalementioning

confidence: 99%

The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale

Parker¹,

McGirt

Bekelis

et al. 2015

FOC

View full text Add to dashboard Cite

Meaningful quality measurement and public reporting have the potential to facilitate targeted outcome improvement, practice-based learning, shared decision making, and effective resource utilization. Recent developments in national quality reporting programs, such as the Centers for Medicare & Medicaid Services Qualified Clinical Data Registry (QCDR) reporting option, have enhanced the ability of specialty groups to develop relevant quality measures of the care they deliver. QCDRs will complete the collection and submission of Physician Quality Reporting System (PQRS) quality measures data on behalf of individual eligible professionals. The National Neurosurgery Quality and Outcomes Database (N2QOD) offers 21 non-PQRS measures, initially focused on spine procedures, which are the first specialty-specific measures for neurosurgery. Securing QCDR status for N2QOD is a tremendously important accomplishment for our specialty. This program will ensure that data collected through our registries and used for PQRS is meaningful for neurosurgeons, related spine care practitioners, their patients, and other stakeholders. The 2015 N2QOD QCDR is further evidence of neurosurgery’s commitment to substantively advancing the health care quality paradigm. The following manuscript outlines the measures now approved for use in the 2015 N2QOD QCDR. Measure specifications (measure type and descriptions, related measures, if any, as well as relevant National Quality Strategy domain[s]) along with rationale are provided for each measure.

show abstract

Risk Factors for Venous Thromboembolism After Spine Surgery

Abstract: Supplemental Digital Content is available in the text

Cited by 65 publications

References 19 publications

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

Complications and 30-day Outcomes Associated With Venous Thromboembolism in the Pediatric Orthopaedic Surgical Population

Factors predicting venous thromboembolism after spine surgery

The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale

Contact Info

Product

Resources

About