The Incidence and Mortality of Thromboembolic Events in Lumbar Spine Surgery
The Incidence and Mortality of Thromboembolic Events in Lumbar Spine Surgery
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DOI：
10.1097/brs.0b013e318286b7c0
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发表时间：
2013-06-01
期刊：
影响因子：
3
通讯作者：
Singh, Kern
中科院分区：
文献类型：
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作者：
Fineberg, Steven J.;Oglesby, Matthew;Singh, Kern
研究设计。回溯性数据库分析。对人群数据库进行分析，以确定腰椎手术后血栓栓子事件的发生率、危险因素和死亡率。肺栓塞(PE)和深静脉血栓形成(DVT)是骨科手术后可能发生的潜在并发症。腰椎手术后这些并发症的发生率没有很好的特征。来自全国住院患者样本的数据是从2002-2009年获得的。对因退行性疾病接受腰椎减压术(LD)或腰椎融合术(LF)的患者进行鉴定。计算急性PE和DVT的发生率和死亡率。使用改良的Charlson共病指数计算合并症。统计分析使用离散变量的学生t检验和。2分类数据检验。Logistic回归用于确定血栓栓塞症事件的独立预测因素。P值小于或等于0.0005表示有统计学意义。从2002-2009年间，共确定了578,457个LD和LFS。LD组和LF组DVT发生率分别为2.4/1000例和4.3/1000例。LD组和LF组的PE发生率分别为1.0/1000例和2.6/1000例。与接受过LD的患者相比，接受了LF并血栓事件的患者更年轻，合并症更少，产生的费用更高。有统计学意义的DVT预测因素是肺循环障碍、凝血障碍、水/电解质紊乱、贫血、肥胖、教学医院状况和较大的医院。预测PE发生的危险因素有肺循环障碍、水/电解质紊乱、贫血、黑人和教职工医院状况。接受LD或LF治疗的患者有发生血栓栓子事件的固有风险。LF术后DVT和PE更为常见。术前肺循环障碍、水/电解质紊乱、缺乏性贫血和教学医院状况是发生DVT和PE的重要危险因素。对有危险的患者采取预防措施可能会减少血栓栓子事件的发生率。
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. 2 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 signifi cant 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 signifi cant risk factors for developing both DVT and PE. Preventive measures in patients at risk may decrease the incidence of thromboembolic events.