*Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, TX; and †Statistical Consulting Laboratory, University of Texas at El Paso, El Paso, TX.
Spine (Phila Pa 1976). 2013 Oct 1;38(21):1892-8. doi: 10.1097/BRS.0b013e31829fc3a0.
Retrospective analysis of a prospectively collected data set.
Identify the incidence of, and risk factors for, deep venous thrombosis (DVT) and pulmonary embolism (PE) after spine surgery.
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.
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.
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.
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.
回顾性分析前瞻性收集的数据。
确定脊柱手术后深静脉血栓形成（DVT）和肺栓塞（PE）的发生率和危险因素。
由于文献的不完善，包括对 DVT 和 PE 发生率的不完全了解，以及无法量化患者的特定危险因素，因此对脊柱手术后化学预防的理想人选的确定受到限制。
查询 2005 年至 2011 年国家手术质量改进计划的数据组，以确定所有接受过脊柱手术的个体。为符合纳入标准的所有个体提取人口统计学数据、合并症、手术特征以及 DVT、PE 和/或死亡率。进行未调整的单变量分析，以确定与手术后发生 DVT 或 PE 相关的潜在变量。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。在多变量检验后保持显著性的预测变量被认为对 DVT 和/或 PE 的发生有影响。
该队列中有 27730 名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%。发生 87 例死亡（0.3%）。静脉血栓栓塞率为 1%，206 例（0.7%）发生 DVT，113 例（0.4%）发生 PE。体重指数 40 及以上、年龄 80 岁及以上、手术时间超过 261 分钟以及美国麻醉医师协会分类 3 级或以上被确定为 DVT 的显著独立预测因子，而体重指数 40 及以上、手术时间超过 261 分钟和男性与 PE 的发生相关。
确定了脊柱手术后发生 DVT 和/或 PE 的多个独立危险因素。具有这些特征的患者可能需要额外的咨询、手术方式修改或预防静脉血栓栓塞事件。
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