Comparison of inpatient versus post-discharge venous thromboembolic events after spinal surgery: A single institution series of 6869 consecutive patients.
Clin Neurol Neurosurg
; 196: 105982, 2020 09.
Article
en En
| MEDLINE
| ID: mdl-32570019
ABSTRACT
STUDY DESIGN:
retrospective chart review.OBJECTIVE:
We aimed to determine the perioperative risk factors that lead to inpatient or post-discharge venous thromboembolism (VTE) events after spinal surgery. SUMMARY OF BACKGROUND DATA While many studies relate the risk factors in a post-surgical setting to the incidence of VTE, this study aims to separate these VTE into inpatient and post-discharge categories to examine timing and risk factors.METHODS:
We analyzed 6869 patients from 2009 to 2015 using Current Procedural Technology codes from a single tertiary academic institution. Patients were stratified based on occurrence and setting of VTE then controlled for perioperative characteristics with exclusion criteria being patients undergoing minor spine surgeries or secondary procedures.RESULTS:
In 170 VTE events, these factors were associated with increased risk for Inpatient DVT only IVC filter (OR 6.380 [3.414-11.924]), longer length of hospital stay (OR 1.083 [1.047-1.120]), a prior history of DVT (OR 3.640 [1.931-6.856]). Post-discharge DVT only history of PE (OR 45.142 [6.785-300.351]), having a corpectomy (OR 26.670 [3.477-204.548]), and having an osteotomy (OR 18.877 [1.129-315.534]). Inpatient PE only surgery >4 h (OR 30.820, p < 0.001), fracture (OR 6.913, p = 0.004), IVC filter (OR 3.135, p = 0.029). Post-discharge PE only corpectomy (OR 541.271, p = 0.009), foraminotomy (OR 40.137, p = 0.013), EBL > 500cc (OR 2467.798, p = 0.002). Time to onset of VTE events was significantly longer for patients undergoing osteotomy (7.43 days) than for patients with fracture (4.28 days), which is consistent with our findings that fracture was an independent predictor of inpatient VTE, and osteotomy was an independent predictor of post-discharge VTE (p = 0.018).CONCLUSIONS:
Time-to-VTE varies between types of surgeries. Some risk factors are independently associated with VTE at all times during the 30-day postoperative period, while other factors are only associated with either inpatient or post-discharge VTE. Those patients with high-risk features for post-discharge VTE merit increased study for thromboprophylaxis management.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Pacientes Ambulatorios
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Complicaciones Posoperatorias
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Embolia Pulmonar
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Procedimientos Neuroquirúrgicos
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Procedimientos Ortopédicos
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Trombosis de la Vena
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Tromboembolia Venosa
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Pacientes Internos
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Anticoagulantes
Tipo de estudio:
Etiology_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Clin Neurol Neurosurg
Año:
2020
Tipo del documento:
Article