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Venous Thromboembolism in Spine Surgery
Perspectives Commentary on: Venous Thromboembolism After Thoracic/ Thoracolumbar Spinal Fusion by Hayden Gephart et al. pp. 545-552.
Ziya L. Gokaslan, M.D. Professor, Department of Neurosurgery Johns Hopkins University
Venous Thromboembolism in Spine Surgery Ali A. Baaj and Ziya L. Gokaslan
P
ostoperative venous thromboembolism (VTE) events constitute a major etiology of morbidity and mortality after spinal surgery. These untoward events remain elusive in terms of predictability and prevention. Classic teaching attributes thrombosis to Virchow’s triad of alterations in normal blood flow, injury to the vascular endothelium, and hypercoagubility. Clinically, risk factors for thromboembolism events include malignancy, obesity, restricted mobility, and smoking. Unfortunately, many patients needing thoracolumbar spine surgery have these same risk factors.
Querying of this database using the appropriate International Statistical Classification of Diseases and Related Health Problems, 9th edition, diagnostic codes revealed that the overall rate of VTE in more than 430,000 patients undergoing spinal fusion is 0.40%, with thoracic and thoracolumbar cases at 1.90%. Analysis of this subgroup revealed that age, expected payer, surgical approach, and comorbidity score were all significantly associated with VTE rates. Combined anterior and posterior surgical approach is independently associated with higher odds of VTE compared with posterior-only surgical approach.
In this issue of WORLD NEUROSURGERY, Gephart et al. examine the incidence and predictors of VTEs using data from the Nationwide Inpatient Sample. This national healthcare database is invaluable as it provides hospital discharge data from a 20% stratified sample of all U.S. hospitals. Notwithstanding the inherent limitations of retrospective administrative database analyses, it remains an excellent resource for large-scale population trend studies (1–3).
These data and analyses all point to one fact: to date, deep venous thromboses and pulmonary emboli remain virtually unavoidable in complex spinal surgery. For every 100 thoracolumbar fusion cases, close to 2 patients will suffer a VTE event, according to these data. The incidence, morbidity, and potential mortality from these events need to be part of the preoperative discussion with the patient. Concomitantly, efforts to further decrease the incidence of these events need to continue.
REFERENCES 1. Baaj AA, Downes K, Vaccaro AR, Uribe JS, Vale FL: Trends in the treatment of lumbar spine fractures in the United States: a socioeconomics perspecrtive. J Neurosurg Spine 15:367-370, 2011. 2. Baaj AA, Uribe JS, Nichols TA, Theodore N, Crawford NR, Sonntag VK, Vale FL: Healthcare
Key words 䡲 Deep-venous thrombosis 䡲 Pulmonary embolism 䡲 Spine surgery 䡲 Thoracic 䡲 Thoracolumbar 䡲 Venous thromboembolism
burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period. J Neurosurg Spine 13:61-66, 2010.
Citation: World Neurosurg. (2012) 78, 5:433. DOI: 10.1016/j.wneu.2012.01.045 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com
3. Boakye M, Patil CG, Ho C, Lad SP: Cervical corpectomy: complications and outcomes. Neurosurgery 63:295-301 [discussion: 301-302], 2008.
Abbreviations and Acronyms VTE: Venous thromboembolism
WORLD NEUROSURGERY 78 [5]: 433, NOVEMBER 2012
1878-8750/$ - see front matter © 2012 Published by Elsevier Inc.
Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA To whom correspondence should be addressed: Ziya L. Gokaslan, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2012) 78, 5:433. DOI: 10.1016/j.wneu.2012.01.045
www.WORLDNEUROSURGERY.org
433
Ziya L. Gokaslan, M.D. Professor, Department of Neurosurgery Johns Hopkins University
Venous Thromboembolism in Spine Surgery Ali A. Baaj and Ziya L. Gokaslan
P
ostoperative venous thromboembolism (VTE) events constitute a major etiology of morbidity and mortality after spinal surgery. These untoward events remain elusive in terms of predictability and prevention. Classic teaching attributes thrombosis to Virchow’s triad of alterations in normal blood flow, injury to the vascular endothelium, and hypercoagubility. Clinically, risk factors for thromboembolism events include malignancy, obesity, restricted mobility, and smoking. Unfortunately, many patients needing thoracolumbar spine surgery have these same risk factors.
Querying of this database using the appropriate International Statistical Classification of Diseases and Related Health Problems, 9th edition, diagnostic codes revealed that the overall rate of VTE in more than 430,000 patients undergoing spinal fusion is 0.40%, with thoracic and thoracolumbar cases at 1.90%. Analysis of this subgroup revealed that age, expected payer, surgical approach, and comorbidity score were all significantly associated with VTE rates. Combined anterior and posterior surgical approach is independently associated with higher odds of VTE compared with posterior-only surgical approach.
In this issue of WORLD NEUROSURGERY, Gephart et al. examine the incidence and predictors of VTEs using data from the Nationwide Inpatient Sample. This national healthcare database is invaluable as it provides hospital discharge data from a 20% stratified sample of all U.S. hospitals. Notwithstanding the inherent limitations of retrospective administrative database analyses, it remains an excellent resource for large-scale population trend studies (1–3).
These data and analyses all point to one fact: to date, deep venous thromboses and pulmonary emboli remain virtually unavoidable in complex spinal surgery. For every 100 thoracolumbar fusion cases, close to 2 patients will suffer a VTE event, according to these data. The incidence, morbidity, and potential mortality from these events need to be part of the preoperative discussion with the patient. Concomitantly, efforts to further decrease the incidence of these events need to continue.
REFERENCES 1. Baaj AA, Downes K, Vaccaro AR, Uribe JS, Vale FL: Trends in the treatment of lumbar spine fractures in the United States: a socioeconomics perspecrtive. J Neurosurg Spine 15:367-370, 2011. 2. Baaj AA, Uribe JS, Nichols TA, Theodore N, Crawford NR, Sonntag VK, Vale FL: Healthcare
Key words 䡲 Deep-venous thrombosis 䡲 Pulmonary embolism 䡲 Spine surgery 䡲 Thoracic 䡲 Thoracolumbar 䡲 Venous thromboembolism
burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period. J Neurosurg Spine 13:61-66, 2010.
Citation: World Neurosurg. (2012) 78, 5:433. DOI: 10.1016/j.wneu.2012.01.045 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com
3. Boakye M, Patil CG, Ho C, Lad SP: Cervical corpectomy: complications and outcomes. Neurosurgery 63:295-301 [discussion: 301-302], 2008.
Abbreviations and Acronyms VTE: Venous thromboembolism
WORLD NEUROSURGERY 78 [5]: 433, NOVEMBER 2012
1878-8750/$ - see front matter © 2012 Published by Elsevier Inc.
Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA To whom correspondence should be addressed: Ziya L. Gokaslan, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2012) 78, 5:433. DOI: 10.1016/j.wneu.2012.01.045
www.WORLDNEUROSURGERY.org
433