Postoperative venous thromboembolic events after spine decompression and fusion are serious complications for patients.
A new study published in the May 15 issue of Spine examines 357,926 patients who underwent either spinal decompression alone or spinal decompression with fusion and found a 1.37 percent VTE rate. William W. Schairer, MD, Andrew C. Pedtke, MD, and Serena S. Hu, MD, authored the article.
The researchers examined different factors associated with VTE. Here are five things to know based on their findings and additional analysis:
1. There instances of VTE varied widely based on diagnosis. There was a 1.03 percent VTE rate for patients with structural degenerative diagnoses, compared to 10.7 percent VTE rate for patients with spinal infections. A separate study published in the Journal of Thrombosis and Haemostasis in 2011 examines optimal VTE prophylaxis after spine surgery using data from 244 hospitals in the United States. There were 26.2 percent of the hospitals providing prophylaxis to more than 90 percent of spinal fusion patients. Another 33.2 percent provided prophylaxis to fewer than 50 percent of their patients.
2. Patients undergoing posterior cervical fusion had a higher VTE rate than patients undergoing anterior cervical fusion. However, anterior thoracolumbar and lumbosacral fusion patients had the highest rates when compared with the other approaches. According to a Medscape report, patients who developed VTE stayed in the hospital approximately 10 days longer than those without VTE.
3. There were also several VTE cases discovered after discharge; 40 percent of those cases were diagnosed at a different hospital than where the patients had surgery. When the diagnosis is made at different hospitals, the primary physician may be unaware of the complication. "It is important to risk-stratify patients who present for spine surgery to identify patients at increased risk who should be monitored for the development of VTE," concluded the study authors. "These results from a large section of historical patients may provide a tool for estimating patient risk depending on diagnosis and type of procedure."
4. Risk factors for VTE include long spine fusions and patients undergoing multiple procedures during hospitalization. Additional risk factors were reported in the Medscape report, including older age, male sex, black ethnicity, anemia, obesity and electrolyte disorders were all risk factors. However, having a pulmonary circulation disorder was the most significant risk factor for VTE.
5. The Medscape report shows hospital costs doubled for lumbar fusion patients with VTE from around $25,000 to $50,000. Increased costs were associated with the longer hospitalization, additional diagnostic tests and treating the VTE. The report also mentioned in-hospital mortality rates increased more than 15-fold when deep vein thrombosis was present. Finally, patients treated at hospitals with larger bed sizes and teaching hospitals had an increased risk of developing VTE.
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