Kim Han Jo, Iyer Sravisht, Diebo Basel G, Kelly Michael P, Sciubba Daniel, Schwab Frank, Lafage Virginie, Mundis Gregory M, Shaffrey Christopher I, Smith Justin S, Hart Robert, Burton Douglas, Bess Shay, Klineberg Eric O
Hospital for Special Surgery, New York, NY, USA.
Washington University, St Louis, MO, USA.
Global Spine J. 2018 May;8(3):224-230. doi: 10.1177/2192568217724781. Epub 2017 Sep 12.
Retrospective cohort study.
Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery.
ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE.
A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, < .01) and more likely to have osteoporosis (29% vs 15.1%, = .037) and liver disease (6.5% vs 1.4%, = .027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, < .01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, = .028). VTE patients had a longer hospital stay (10 vs 7 days, < .05) and higher mortality rate (6.3% vs 0.7%, < .01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE ( = .11, area under the curve = 0.74, < .05).
The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.
回顾性队列研究。
描述成人脊柱畸形（ASD）手术中静脉血栓栓塞事件（VTE，定义为深静脉血栓形成[DVT]和/或肺栓塞[PE]）的发生率及危险因素。
在前瞻性多中心数据库中识别出患有VTE的ASD患者。检查并发症、翻修情况及死亡率。将患者的人口统计学资料、手术细节、影像学和临床结果与非VTE组进行比较。采用多变量二元回归模型确定VTE的预测因素。
共识别出737例患者，32例（4.3%）发生VTE（DVT = 14例；PE = 18例）。在基线时，VTE患者从事体力劳动工作的可能性较小（59.4%对79.7%，P <.01），患骨质疏松症的可能性更大（29%对15.1%，P =.037），患肝病的可能性更大（6.5%对1.4%，P =.027）。VTE患者术前矢状面垂直轴（SVA）更大（93 mm对55 mm，P <.01），且SVA矫正幅度更大。VTE与前后联合入路相关（45%对25%，P =.028）。VTE患者住院时间更长（10天对7天，P <.05），死亡率更高（6.3%对0.7%，P <.01）。多变量分析表明，骨质疏松症、缺乏体力劳动和SVA矫正增加是VTE的独立预测因素（P =.11，曲线下面积 = 0.74，P <.
ASD中VTE的发生率为4.3%，DVT发生率为1.9%，PE发生率为2.4%。骨质疏松症、缺乏体力劳动和SVA矫正增加是VTE的独立预测因素。与非VTE患者相比，VTE患者的死亡率更高。
