Prevalence of Risk Factors for Hospital-Acquired Venous Thromboembolism in Neurosurgery and Orthopedic Spine Surgery Patients.

Autor:	Fischer CR; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Wang E; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Steinmetz L; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Vasquez-Montes D; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Buckland A; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Bendo J; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Frempong-Boadu A; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York., Errico T; Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York.
Jazyk:	angličtina
Zdroj:	International journal of spine surgery [Int J Spine Surg] 2020 Feb 29; Vol. 14 (1), pp. 79-86. Date of Electronic Publication: 2020 Feb 29 (Print Publication: 2020).
DOI:	10.14444/7011
Abstrakt:	Background: Hospital-acquired venous thromboembolisms (HA-VTE) are a significant source of morbidity and mortality in spine surgery patients. The purpose of this study was to review HA-VTE rates at our institution and evaluate the prevalence of known risk factors in patients who developed HA-VTE among both neurosurgical and orthopedic spine surgeries. Methods: Retrospective chart reviews were conducted of all spine surgery patients from January 1, 2013, to July 31, 2017, to evaluate rates of HA-VTE and prevalence of known HA-VTE risk factors among these patients. Univariate and multivariate logistic regression analysis for categorical variables and independent Student t test for continuous variables were utilized with significance set at P  < .05. Results: The overall HA-VTE rate was 0.94% (0.61% orthopedic, 1.87% neurosurgery). Patients with VTEs had higher rates of thoracic procedure ( P  = .002), posterior approach ( P  = .001), diagnosis of fracture ( P  = .013) or flatback syndrome ( P  = .028), neurosurgery division ( P  < .001), and diagnosis-related group (DRG) of noncervical malignancy ( P  = .001). Patients with VTEs had lower rates of cervical procedure ( P  < .001), diagnosis of herniated nucleus pulposus ( P  = .006) and degenerative disc disease ( P  = .001), and DRG of cervical spine fusion ( P  < .001). In the patients who sustained VTE, the neurosurgical patients had higher rates of active cancer (22.86% vs 0%, P  = .004) and age >60 (80% vs 50%, P  < .001), and orthopedic patients had higher estimated blood loss (EBL) (2436 ml vs 1176 mL, P  = .006) and rates of anterior-posterior surgery (22.58% vs 0%, P  = .003). Neurosurgery department, diagnosis of fracture, and DRG of noncervical malignancy were found to be significant independent risks for developing HA-VTE. Cervical procedures were independently associated with significantly lower risk. Postoperative anticoagulation initiated sooner in neurosurgery patients (postoperative day 1.26 vs 3.19, P  < .001). Conclusions: The overall HA-VTE rate at our institution was 0.94% (0.61% orthopedic, 1.87% neurosurgery). In patients who sustained VTE, neurosurgical patients had higher rates of active cancer and age >60 years, and orthopedic patients had higher EBL and rates of anterior-posterior surgery. This highlights the different patient populations between the 2 departments and the need for individualized thromboprophylaxis regimens. Level of Evidence: 4. Competing Interests: Disclosures and COI: Each institution obtained approval from its local institutional review board to enroll patients in the prospective database, and informed consent was obtained from each patient. (©International Society for the Advancement of Spine Surgery 2020.)
Databáze:	MEDLINE
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