Patient-Based and Surgical Characteristics Associated With the Acute Development of Deep Venous Thrombosis and Pulmonary Embolism After Spine Surgery
Patient-Based and Surgical Characteristics Associated With the Acute Development of Deep Venous Thrombosis and Pulmonary Embolism After Spine Surgery
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DOI：
10.1097/brs.0b013e31829fc3a0
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发表时间：
2013-10-01
期刊：
影响因子：
3
通讯作者：
Belmont, Philip J., Jr.
中科院分区：
文献类型：
--
作者：
Schoenfeld, Andrew J.;Herzog, Joshua P.;Belmont, Philip J., Jr.
研究设计.前瞻性收集数据集的回顾性分析。明确脊柱手术后深静脉血栓形成（DVT）和肺栓塞（PE）的发病率和危险因素。脊柱手术后化学预防的理想候选者的确定受到文献状态的限制，包括对DVT和PE发生率的不完全理解，以及无法量化患者中的特定风险因素。查询2005年至2011年国家手术质量改进计划的数据集，以识别所有接受脊柱手术的个体。对所有符合入选标准的个体提取人口统计学数据、医学合并症、手术特征和DVT、PE和/或死亡率。进行了未校正的单变量分析，以确定与术后DVT或PE发生潜在相关的变量。随后进行多变量逻辑回归检验，控制模型中存在的其他因素。多变量检验后保持显著性的预测变量被认为对DVT和/或PE的发展有影响。该队列中有27，730例患者接受了脊柱手术。平均年龄为56.4（+/- 15.1）岁。腰椎手术占干预的61%。死亡87例（0.3%）。静脉血栓栓塞率为1%，206例（0.7%）患者持续DVT，113例（0.4%）患者发生PE。体重指数≥ 40、年龄≥ 80岁、手术时间≥ 261分钟、美国麻醉医师学会分级≥ 3级是DVT的独立预测因子，而体重指数≥ 40、手术时间≥ 261分钟、男性与PE的发生相关。确定了脊柱手术后发生DVT和/或PE的多个独立风险因素。具有这些特征的患者可能需要额外的咨询、手术修改或预防静脉血栓栓塞事件。
Study Design. Retrospective analysis of a prospectively collected data set.Objective. Identify the incidence of, and risk factors for, deep venous thrombosis (DVT) and pulmonary embolism (PE) after spine surgery.Summary of Background Data. Determination of ideal candidates for chemoprophylaxis after spine surgery is limited by the state of the literature, including incomplete understanding regarding the incidence of DVT and PE, as well as an inability to quantify specific risk factors among patients.Methods. The 2005 to 2011 data set of the National Surgical Quality Improvement Program was queried to identify all individuals having undergone spine surgery. Demographic data, medical comorbidities, surgical characteristics, and the presence of DVT, PE, and/or mortality were abstracted for all individuals meeting inclusion criteria. Unadjusted univariate analysis was performed to identify variables that were potentially associated with the development of DVT or PE after surgery. A multivariate logistic regression test, controlling for other factors present in the model, was subsequently performed. Predictor variables that maintained significance after multivariate testing were considered influential in the development of DVT and/or PE.Results. There were 27,730 patients who received spine procedures in this cohort. The average age was 56.4 (+/- 15.1) years. Lumbar spine procedures made up 61% of interventions. Death occurred in 87 instances (0.3%). The venous thromboembolic rate was 1%, with 206 individuals (0.7%) sustaining DVT and 113 (0.4%) developing a PE. Body mass index 40 and greater, age 80 years and older, operative time exceeding 261 minutes, and American Society of Anesthesiologists classification 3 or higher were identified as significant independent predictors of DVT, whereas body mass index 40 and greater, operative time exceeding 261 minutes, and male sex were associated with the development of PE.Conclusion. Multiple independent risk factors for the development of DVT and/or PE after spine surgery were identified. Patients with these characteristics may require additional counseling, procedural modification, or prophylaxis against venous thromboembolic events.