title: Risk factors associated with venous thromboembolism in patients undergoing spine surgery.
abstract: OBJECTIVE Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients. METHODS The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006-2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE. RESULTS Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration > 4 hours, emergency presentation, and American Society of Anesthesiologists Class III-V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of ≥ 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726-0.787). CONCLUSIONS A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Keaton
authors: K
authors: Piper
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Hanna
authors: H
authors: Algattas
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Ian A
authors: IA
authors: DeAndrea-Lazarus
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Kristopher T
authors: KT
authors: Kimmell
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Yan Michael
authors: YM
authors: Li
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Kevin A
authors: KA
authors: Walter
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: Howard J
authors: HJ
authors: Silberstein
authors: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors: G Edward
authors: GE
authors: Vates
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012306:Risk; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D054556:Venous Thromboembolism / Q000453:epidemiology*
keywords: ACS = American College of Surgeons; ACS NSQIP; ASA = American Society of Anesthesiologists; AUC = area under the curve; BMI = body mass index; CPT = Current Procedural Terminology; DVT = deep venous thromboembolism; NSQIP = National Surgical Quality Improvement Project; PE = pulmonary embolism; SCR = surgical clinician reviewer; VTE = venous thromboembolism; quality; risk score; spine surgery; venous thromboembolism