Goz Vadim, McCarthy Ian, Weinreb Jeffrey H, Dallas Kai, Bendo John A, Lafage Virginie, Errico Thomas J
Spine Research Institute, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 306 East 15th Street, Ground Floor, New York, NY 10003. E-mail address for V. Goz:
Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 North Central Expressway, Suite 500, LB 81, Dallas, TX 75246.
J Bone Joint Surg Am. 2014 Jun 4;96(11):936-942. doi: 10.2106/JBJS.L.01602.
Postoperative venous thromboembolic events (VTEs), which include pulmonary emboli and deep venous thromboses, are potentially preventable causes of death. The aim of this study was to investigate the patient and procedure-related risk factors for the occurrence of VTEs in patients undergoing spinal fusion.
We used ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) procedure codes to identify patients in the Nationwide Inpatient Sample (NIS) database for 2001 through 2010 who were treated with spinal fusion. The occurrence of a symptomatic VTE was identified with use of ICD-9-CM diagnosis codes. Patient demographics, hospital characteristics, and comorbidities in the VTE and non-VTE groups were analyzed, and independent risk factors for VTE were identified.
A total of 710,154 spinal fusion procedures were identified in the NIS from 2001 to 2010, and 3525 (0.50%) of these patients were recorded as having 3777 VTEs, consisting of 2038 deep venous thromboses (0.29%) and 1739 pulmonary emboli (0.24%). Patients with a VTE were older on average (57.63 years compared with 52.88 years for patients without a VTE) and more often male (VTE incidence, 0.58% compared with 0.42% for female) and black (VTE incidence, 0.78% compared with 0.47% for white). Postoperative VTE occurrence was associated with a longer hospital stay (18.0 compared with 3.94 days) and higher total hospital charges ($207,253 compared with $66,823). A number of comorbidities and procedure-related factors were identified as independent risk factors for VTE.
We present a VTE Risk Index, based on the independent risk factors identified in this study, for the VTE following spinal fusion. In conjunction with current guidelines, this risk index can be used to guide clinical decision-making regarding VTE prophylaxis in patients undergoing spinal fusion.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
术后静脉血栓栓塞事件（VTEs），包括肺栓塞和深静脉血栓形成，是潜在可预防的死亡原因。本研究的目的是调查接受脊柱融合手术患者发生VTEs的患者及手术相关危险因素。
我们使用ICD-9-CM（国际疾病分类，第9版，临床修订版）手术编码，在2001年至2010年全国住院患者样本（NIS）数据库中识别接受脊柱融合治疗的患者。使用ICD-9-CM诊断编码确定有症状VTE的发生情况。分析VTE组和非VTE组患者的人口统计学特征、医院特征和合并症，并确定VTE的独立危险因素。
2001年至2010年在NIS中总共识别出710,154例脊柱融合手术，其中3525例（0.50%）患者记录有3777次VTEs，包括2038次深静脉血栓形成（0.29%）和1739次肺栓塞（0.24%）。发生VTE的患者平均年龄较大（57.63岁，无VTE患者为52.88岁），男性更常见（VTE发生率，男性为0.58%，女性为0.42%），黑人更常见（VTE发生率，黑人为0.78%，白人为0.47%）。术后VTE的发生与住院时间延长（18.0天对比3.94天）和医院总费用较高（207,253美元对比66,823美元）相关。多种合并症和手术相关因素被确定为VTE的独立危险因素。
我们基于本研究中确定的独立危险因素，提出了脊柱融合术后VTE的风险指数。结合当前指南，该风险指数可用于指导脊柱融合手术患者VTE预防的临床决策。
预后III级。有关证据水平的完整描述，请参阅作者指南。
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