Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA.
Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA.
World Neurosurg. 2020 Dec;144:e460-e465. doi: 10.1016/j.wneu.2020.08.182. Epub 2020 Sep 2.
Few studies provide insight into risk factors (RFs) associated with postoperative deep vein thrombosis (DVT) following elective spinal surgery. DVTs are detrimental in this population because of the risk of pulmonary embolization or surgical site hemorrhage with treatment.
Elective spine surgery patients have a low incidence of DVT, thus a case-control study was selected to investigate RFs associated with postoperative, symptomatic DVT.
Cases were matched to controls in a 1:2 ratio based on surgery type. Risk of having a prior DVT and choice of subcutaneous heparin dosing following surgery was analyzed in a multivariate regression model with other potentially confounding variables.
A total of 195 patients were included in this study. Independent of patient age, history of DVT was associated with postoperative symptomatic DVT (odds ratio [OR], 4.09; 95% confidence interval [CI], 1.22-13.78). Two versus 3 times daily postoperative heparin dosing (OR, 1.56; 95% CI, 0.32-7.56), surgery length (OR, 1.32; 95% CI, 0.98-1.79), and patient age (OR, 1.04; 95% CI, 1.0-1.08) were not statistically significant, independent RFs. Older age and longer length of surgery trended toward association with DVT without reaching significance. Length of stay was increased from 3-5 days (P < 0.001) in DVT patients compared with controls.
These results suggest that patients with a history of DVT undergoing elective spinal surgery are at higher risk of developing symptomatic DVT postoperatively resulting in significantly increased length of stay. Further studies on additional preoperative screening and medical optimization in elective spine surgery patients may help reduce the rate of symptomatic, postoperative DVT.
很少有研究深入探讨与择期脊柱手术后深静脉血栓形成（DVT）相关的风险因素（RFs）。由于治疗过程中存在肺栓塞或手术部位出血的风险，DVT 在该人群中是有害的。
择期脊柱手术患者的 DVT 发病率较低，因此选择病例对照研究来调查与术后症状性 DVT 相关的 RFs。
根据手术类型，以 1:2 的比例将病例与对照进行匹配。在多变量回归模型中分析了既往 DVT 风险和术后皮下肝素剂量选择与其他潜在混杂变量之间的关系。
本研究共纳入 195 例患者。无论患者年龄如何，既往 DVT 史与术后症状性 DVT 相关（比值比 [OR]，4.09；95%置信区间 [CI]，1.22-13.78）。术后每日 2 次与 3 次肝素给药（OR，1.56；95%CI，0.32-7.56）、手术时间（OR，1.32；95%CI，0.98-1.79）和患者年龄（OR，1.04；95%CI，1.0-1.08）不是统计学上的独立 RFs。年龄较大和手术时间较长与 DVT 呈相关趋势，但无统计学意义。与对照组相比，DVT 患者的住院时间从 3-5 天增加（P<0.001）。
这些结果表明，有 DVT 病史的患者行择期脊柱手术，术后发生症状性 DVT 的风险较高，导致住院时间显著延长。进一步研究额外的术前筛查和择期脊柱手术患者的医疗优化可能有助于降低症状性术后 DVT 的发生率。
