title: Venous thromboembolism after thoracic/thoracolumbar spinal fusion.
abstract: OBJECTIVE
  Venous thromboembolism (VTE), which includes deep venous thrombosis and pulmonary embolism, is a serious and potentially fatal surgical complication. The goal of our study was to examine preoperative characteristics, incidence, and outcomes of patients with VTE after elective thoracic/thoracolumbar level spine fusion.
  
  
  METHODS
  We identified 430,081 patients from the Nationwide Inpatient Sample database who underwent spinal fusion between 2002 and 2008. Patients undergoing thoracic/thoracolumbar level fusion (n = 8617) were found to have the greatest concurrent rate of VTE. We then performed multivariate analyses on this cohort to identify predictors of and outcomes after VTE in patients undergoing thoracic/thoracolumbar level fusion.
  
  
  RESULTS
  The overall VTE rate in spinal fusion surgery was 0.40% (cervical = 0.22%, thoracic/thoracolumbar = 1.90%, lumbar/lumbosacral = 0.49%, re-fusions = 0.64%, and fusions not otherwise specified = 0.84%). On multivariate logistic regression analysis of patients undergoing spinal fusion at the thoracic/thoracolumbar level, increasing age, Medicare insurance coverage (vs. private insurance), urban teaching hospital (vs. urban nonteaching hospital), combined anterior/posterior surgical approach (vs. posterior-only approach), and the presence of congestive heart failure or weight loss (Elixhauser comorbidity groups) were each independently associated with an increased odds ratio of VTE complication. VTE after thoracic/thoracolumbar surgery was significantly associated with longer hospital stays (16.6 vs. 6.74 days), increased total hospital costs ($260,208 vs. $115,474), and increased mortality (4.33% vs. 0.33%).
  
  
  CONCLUSIONS
  Multivariate logistic regression analysis reveals age, insurance status, hospital type, combined anterior/posterior surgical approach, and the presence of congestive heart failure or weight loss to be independently associated with an increased odds ratio of VTE complication. This complication is associated with increased hospital costs, length of stay, and overall mortality.
authors.affiliation: Department of Neurosurgery, Stanford University Hospital and Clinics, Stanford, CA, USA.
authors.forename: Melanie G Hayden
authors.initials: MG
authors.lastname: Gephart
authors.forename: Corinna C
authors.initials: CC
authors.lastname: Zygourakis
authors.forename: Robert T
authors.initials: RT
authors.lastname: Arrigo
authors.forename: Paul S A
authors.initials: PS
authors.lastname: Kalanithi
authors.forename: Shivanand P
authors.initials: SP
authors.lastname: Lad
authors.forename: Maxwell
authors.initials: M
authors.lastname: Boakye
mesh_terms: D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000191:economics / Q000401:mortality; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects* / Q000191:economics / Q000401:mortality*; D013904:Thoracic Vertebrae / Q000601:surgery; D054556:Venous Thromboembolism / Q000191:economics / Q000401:mortality*