Schairer William W, Pedtke Andrew C, Hu Serena S
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
Spine (Phila Pa 1976). 2014 May 15;39(11):911-918. doi: 10.1097/BRS.0000000000000315.
Retrospective cohort study.
To measure the rate of postoperative venous thromboembolic events (VTE) after spine decompression and fusion procedures.
VTE after spine surgery is a serious complication, but chemoprophylaxis is not without significant risk due to the concern of epidural hematoma. Current literature report widely variable rates of VTE, and have weaknesses in sample size, specificity of diagnosis, and methodological problems with adequate patient follow-up.
State-level inpatient, ambulatory surgery, and emergency department administrative databases were used to track patients for clinically significant VTE within 90 days of discharge after a spine procedure.
Of 357,926 patients enrolled, one-third underwent spine decompression alone, whereas two-thirds received a spine fusion. The overall rate of VTE was 1.37% (95% CI: 1.33-1.41), but varied widely depending on diagnosis, 1.03% for structural degenerative diagnoses to 10.7% for spine infection. Posterior cervical fusion had a higher rate of VTE than anterior cervical fusion, whereas anterior thoracolumbar and lumbosacral fusions had higher rates than the respective posterior approaches. Additional risk factors included patients receiving long spine fusions and having multiple procedures during the hospitalization. Forty percent of VTEs discovered after discharge were diagnosed at a different hospital.
The rate of spine VTE varies widely depending on diagnosis and procedure. It is important to risk-stratify patients who present for spine surgery to identify patients at increased risk who should be monitored for the development of VTE. It is important to know that nearly half of VTEs that occur after discharge are diagnosed at different hospitals, and thus the primary surgeon may be initially unaware of the complication. These results from a large selection of historical patients may provide a tool for estimating patient risk depending on diagnosis and type of procedure.
回顾性队列研究。
测量脊柱减压和融合手术后静脉血栓栓塞事件（VTE）的发生率。
脊柱手术后VTE是一种严重并发症，但由于担心硬膜外血肿，化学预防并非没有重大风险。当前文献报道的VTE发生率差异很大，且在样本量、诊断特异性以及患者充分随访的方法学问题上存在不足。
利用州级住院患者、门诊手术和急诊科管理数据库，追踪脊柱手术后出院90天内发生具有临床意义VTE的患者。
在纳入的357,926例患者中，三分之一仅接受脊柱减压，而三分之二接受脊柱融合手术。VTE的总体发生率为1.37%（95%CI：1.33 - 1.41），但因诊断不同差异很大，结构性退行性诊断为1.03%，脊柱感染为10.7%。颈椎后路融合术的VTE发生率高于颈椎前路融合术，而胸腰椎和腰骶椎前路融合术的发生率高于各自的后路手术。其他风险因素包括接受长节段脊柱融合手术的患者以及住院期间接受多次手术的患者。出院后发现的VTE中有40%是在另一家医院诊断的。
脊柱VTE的发生率因诊断和手术方式而异。对接受脊柱手术的患者进行风险分层以识别VTE发生风险增加的患者并对其进行监测非常重要。要知道，近一半的出院后发生的VTE是在不同医院诊断的，因此主刀医生最初可能并未意识到该并发症。这些来自大量历史患者的结果可能为根据诊断和手术类型估计患者风险提供一种工具。
2级
