Risk factors associated with venous thromboembolism in patients undergoing spine surgery

被引:56
作者
Piper, Keaton [1 ]
Algattas, Hanna [1 ]
DeAndrea-Lazarus, Ian A. [1 ]
Kimmel, Kristopher T. [1 ]
Li, Yan Michael [1 ]
Walter, Kevin A. [1 ]
Silberstein, Howard J. [1 ]
Vates, G. Edward [1 ]
机构
[1] Univ Rochester, Med Ctr, Dept Neurosurg, 601 Elmwood Ave,Box 670, Rochester, NY 14642 USA
关键词
venous thromboembolism; spine surgery; ACS NSQIP; quality; risk score; QUALITY-IMPROVEMENT-PROGRAM; COMPLICATIONS; PROPHYLAXIS; THROMBOSIS; OUTCOMES; DISEASE; CARE;
D O I
10.3171/2016.6.SPINE1656
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients. METHODS The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006-2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE. RESULTS Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration > 4 hours, emergency presentation, and American Society of Anesthesiologists Class III-V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of >= 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726-0.787). CONCLUSIONS A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.
引用
收藏
页码:90 / 96
页数:7
相关论文
共 46 条
[1]   Prevention of venous thromboembolism in surgical patients [J].
Agnelli, G .
CIRCULATION, 2004, 110 (24) :4-12
[2]   Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism [J].
Anderson, Frederick A., Jr. ;
Zayaruzny, Maxim ;
Helt, John A. ;
Fidan, Dogan ;
Cohen, Alexander T. .
AMERICAN JOURNAL OF HEMATOLOGY, 2007, 82 (09) :777-782
[3]   Clinical outcome of patients with major bleeding after venous thromboembolism Findings from the RIETE Registry [J].
Antonio Nieto, Jose ;
Camara, Timoteo ;
Gonzalez-Higueras, Elena ;
Ruiz-Gimenez, Nuria ;
Guijarro, Ricardo ;
Javier Marchena, Pablo ;
Monreal, Manuel .
THROMBOSIS AND HAEMOSTASIS, 2008, 100 (05) :789-796
[4]   Lifetime Risk of Venous Thromboembolism in Two Cohort Studies [J].
Bell, Elizabeth J. ;
Lutsey, Pamela L. ;
Basu, Saonli ;
Cushman, Mary ;
Heckbert, Susan R. ;
Lloyd-Jones, Donald M. ;
Folsom, Aaron R. .
AMERICAN JOURNAL OF MEDICINE, 2016, 129 (03) :339.e19-339.e26
[5]   An evidence-based clinical guideline for the use of antithrombotic therapies in spine surgery [J].
Bono, Christopher M. ;
Watters, William C., III ;
Heggeness, Michael H. ;
Resnick, Daniel K. ;
Shaffer, William O. ;
Baisden, Jamie ;
Ben-Galim, Peleg ;
Easa, John E. ;
Fernand, Robert ;
Lamer, Tim ;
Matz, Paul G. ;
Mendel, Richard C. ;
Patel, Rajeev K. ;
Reitman, Charles A. ;
Toton, John F. .
SPINE JOURNAL, 2009, 9 (12) :1046-1051
[6]   Deep Venous Thrombosis and Venous Thromboembolism Prophylaxis [J].
Buesing, Keely L. ;
Mullapudi, Barghava ;
Flowers, Kristin A. .
SURGICAL CLINICS OF NORTH AMERICA, 2015, 95 (02) :285-+
[7]   Prophylaxis against venous thromboembolism in hospitalized medically ill patients: Update and practical approach [J].
Camden, Ryan ;
Ludwig, Shannon .
AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY, 2014, 71 (11) :909-917
[8]   Outcomes in Neurosurgical Patients Who Develop Venous Thromboembolism: A Review of the RIETE Registry [J].
Cote, Lauren P. ;
Greenberg, Steven ;
Caprini, Joseph A. ;
Stone, James ;
Arcelus, Juan I. ;
Lopez-Jimenez, Luciano ;
Rosa, Vladimir ;
Schellong, Sebastian ;
Monreal, Manuel .
CLINICAL AND APPLIED THROMBOSIS-HEMOSTASIS, 2014, 20 (08) :772-778
[9]   Deep venous thrombosis after repair of nonruptured abdominal aneurysm [J].
Davenport, Daniel L. ;
Xenos, Eleftherios S. .
JOURNAL OF VASCULAR SURGERY, 2013, 57 (03) :678-+
[10]   An Algorithmic Approach to Venous Thromboembolism Prophylaxis in Spine Surgery [J].
Eskildsen, Scott M. ;
Moll, Stephan ;
Lim, Moe R. .
JOURNAL OF SPINAL DISORDERS & TECHNIQUES, 2015, 28 (08) :275-281