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The incidence and mortality of thromboembolic events in lumbar spine surgery.

Abstract：

STUDY DESIGN:Retrospective database analysis. OBJECTIVE:A population-based database was analyzed to identify the incidence, risk factors, and mortality associated with thromboembolic events after lumbar spine surgery. SUMMARY OF BACKGROUND DATA:Pulmonary embolism (PE) and deep vein thrombosis (DVT) are potential complications that may occur after orthopedic procedures. The incidence of these complications is not well characterized after lumbar spine surgery. METHODS:Data from the Nationwide Inpatient Sample was obtained from 2002-2009. Patients undergoing lumbar decompression (LD), or lumbar fusion (LF) for degenerative conditions were identified. Acute PE and DVT incidences and mortality rates were calculated. Comorbidities were calculated using a modified Charlson Comorbidity Index. Statistical analysis was performed using the Student t test for discrete variables and χ test for categorical data. Logistic regression was used to identify independent predictors of thromboembolic events. A P value of less than or equal to 0.0005 was used to denote statistical significance. RESULTS:A total 578,457 LDs and LFs were identified from 2002-2009. DVT incidences were 2.4 and 4.3 per 1000 cases in the LD and LF groups, respectively. PE incidences were 1.0 and 2.6 per 1000 cases in the LD and LF groups, respectively. Patients who had undergone LF with thromboembolic events were younger, had fewer comorbidities, and incurred greater costs than patients who had undergone LD. Statistically significant predictors of DVT were pulmonary circulation disorders, coagulopathy, fluid/electrolyte disorders, anemia, obesity, teaching hospital status, and larger hospitals. Predictors for the development of PE were pulmonary circulation disorders, fluid/electrolyte disorders, anemia, black ethnicity and teaching hospital status. CONCLUSION:Patients undergoing LD or LF are at inherent risk of thromboembolic events. DVT and PE are more common after LF procedures. Preoperative pulmonary circulation disorders, fluid/electrolyte disorders, deficiency anemia, and teaching hospital status were significant risk factors for developing both DVT and PE. Preventive measures in patients at risk may decrease the incidence of thromboembolic events. LEVEL OF EVIDENCE:4.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Fineberg SJ,Oglesby M,Patel AA,Pelton MA,Singh K

doi

10.1097/BRS.0b013e318286b7c0

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

1154-9

issue

eissn

0362-2436

issn

1528-1159

journal_volume

pub_type

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The incidence and mortality of thromboembolic events in lumbar spine surgery.