title: The Effect of Coagulopathies on Perioperative Complications and Clinical Outcomes in Patients Treated With Posterior Lumbar Fusions.
abstract: METHODS
  A retrospective database review.
  
  
  OBJECTIVE
  The aim of this study was to compare complication rates following one to two-level lumbar spine surgery in patients with primary hypercoagulable states and coagulopathies.
  
  
  BACKGROUND
  Both hypercoagulable states and coagulopathies are not uncommon conditions that have the potential to significantly alter perioperative patient management. However, there are few studies that document the added risk of medical complications following spine surgery in these patient populations.
  
  
  METHODS
  The PearlDiver database (2005-2012) was utilized to determine perioperative complication rates in patients with primary hypercoagulable states and coagulopathies who underwent primary one to two-level posterolateral lumbar spine fusion. Control cohorts without specific hematologic disorders were matched by demographics and comorbidities. Ninety-day complication rates were determined, along with revision rates at one and two years. When considering complication rate comparisons between matched cohorts, P < 0.005 was considered significant.
  
  
  RESULTS
  In total, 746 patients with coagulopathies and 2753 patients with primary hypercoagulable states were selected. Matched control cohorts contained 74,879 and 54,007 patients, respectively. Hypercoagulable patients had significantly increased rates of medical complications [odds ratio (OR) 1.4], infections (OR 1.6), and venous thromboembolisms (OR 9.0) during the three months following spine surgery and same-day transfusions (OR 1.2) when compared with matched controls (P < 0.001). Patients with von Willebrand disease or hemophilia had increased rates of three-month infections (OR 2.3) and transfusion (OR 2.0) when compared with a matched control group (P < 0.005). One- and two-year revisions rates were not significantly higher for either pathologic cohort when compared to matched controls.
  
  
  CONCLUSIONS
  Both primary hypercoagulable states and coagulopathies increase infection and transfusion rates following one to two-level lumbar spine surgery.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Varun
authors.initials: V
authors.lastname: Puvanesarajah
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Amit
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Shimer
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Francis H
authors.initials: FH
authors.lastname: Shen
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Hamid
authors.initials: H
authors.lastname: Hassanzadeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult