Fischer Charla R, Wang Erik, Steinmetz Leah, Vasquez-Montes Dennis, Buckland Aaron, Bendo John, Frempong-Boadu Anthony, Errico Thomas
Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, New York.
Int J Spine Surg. 2020 Feb 29;14(1):79-86. doi: 10.14444/7011. eCollection 2020 Feb.
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.
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 test for continuous variables were utilized with significance set at < .05.
The overall HA-VTE rate was 0.94% (0.61% orthopedic, 1.87% neurosurgery). Patients with VTEs had higher rates of thoracic procedure ( = .002), posterior approach ( = .001), diagnosis of fracture ( = .013) or flatback syndrome ( = .028), neurosurgery division ( < .001), and diagnosis-related group (DRG) of noncervical malignancy ( = .001). Patients with VTEs had lower rates of cervical procedure ( < .001), diagnosis of herniated nucleus pulposus ( = .006) and degenerative disc disease ( = .001), and DRG of cervical spine fusion ( < .001). In the patients who sustained VTE, the neurosurgical patients had higher rates of active cancer (22.86% vs 0%, = .004) and age >60 (80% vs 50%, < .001), and orthopedic patients had higher estimated blood loss (EBL) (2436 ml vs 1176 mL, = .006) and rates of anterior-posterior surgery (22.58% vs 0%, = .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, < .001).
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.
医院获得性静脉血栓栓塞症（HA-VTE）是脊柱手术患者发病和死亡的重要原因。本研究的目的是回顾我院的HA-VTE发生率，并评估神经外科和骨科脊柱手术中发生HA-VTE的患者中已知危险因素的患病率。
对2013年1月1日至2017年7月31日期间所有脊柱手术患者进行回顾性病历审查，以评估这些患者中HA-VTE的发生率和已知HA-VTE危险因素的患病率。对分类变量进行单因素和多因素逻辑回归分析，对连续变量进行独立样本t检验，显著性设定为P<0.05。
总体HA-VTE发生率为0.94%（骨科为0.61%，神经外科为1.87%）。发生VTE的患者进行胸椎手术的比例更高（P=0.002）、采用后路手术的比例更高（P=0.001）、骨折诊断（P=0.013）或扁平背综合征诊断（P=0.028）、神经外科科室（P<0.001）以及非颈椎恶性肿瘤的诊断相关组（DRG）（P=0.001）。发生VTE的患者进行颈椎手术的比例更低（P<0.001）、椎间盘突出症诊断（P=0.006）和退行性椎间盘疾病诊断（P=0.001）以及颈椎融合的DRG（P<0.001）。在发生VTE的患者中，神经外科患者的活动性癌症发生率更高（22.86%对0%，P=0.004）且年龄>60岁的比例更高（80%对50%，P<0.001），骨科患者的估计失血量（EBL）更高（2436 ml对1176 mL，P=0.006）以及前后路手术比例更高（22.58%对0%，P=0.003）。神经外科科室、骨折诊断以及非颈椎恶性肿瘤的DRG被发现是发生HA-VTE的显著独立危险因素。颈椎手术与显著更低的风险独立相关。神经外科患者术后抗凝开始时间更早（术后第1.26天对3.19天，P<0.001）。
我院的总体HA-VTE发生率为0.94%（骨科为0.61%，神经外科为1.87%）。在发生VTE的患者中，神经外科患者的活动性癌症发生率和年龄>60岁的比例更高，骨科患者的EBL和前后路手术比例更高。这凸显了两个科室患者群体的差异以及个性化血栓预防方案的必要性。
4级。
