Rates of Venous Thromboembolism and Mortality Have Not Improved in Elective Cervical Spine Surgery From 2012 to 2021.

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

This study aimed to (1) identify temporal trends in the rates of venous thromboembolism (VTE), deep vein thrombosis (DVT), pulmonary embolism (PE), and mortality between 2012 and 2021 and (2) evaluate independent predictors of VTE following elective cervical spine surgery.

SUMMARY OF BACKGROUND DATA

Current literature regarding the incidence, trend, and predictors of VTE after cervical spine surgery is severely limited. The lack of published peer-reviewed data has contributed to the significant variability in thromboembolic prophylaxis practice in spine surgery.

METHODS

The ACS-NSQIP database was queried to determine the annual incidences of VTEs, DVTs, PEs, and mortality in cervical spine operations between 2012 and 2021. Multivariate logistic regression models were constructed to evaluate the primary outcomes and identify significant predictors of VTE following cervical spine surgery.

RESULTS

A total of 91,025 patients were included in our study. Annual rates of VTE, DVT, PE, and mortality did not change (all P>0.10) across operation years. Multivariate regression analysis further demonstrated no significant difference in VTEs, DVTs, PEs, and mortality across operation years. Independent predictors of VTE included advanced age, black race, elevated BMI, increased operation time, length of hospital stay, nonhome discharge, history of COPD, functional dependence, and high INR. Protective factors of VTE included female sex, outpatient surgery, and nonsmokers in this cohort.

CONCLUSIONS

Rates of thromboembolic complications following elective cervical spine surgery have not improved over the last decade (2012-2021). Factors such as advanced age, black race, elevated BMI, increased operation time, length of hospital stay, nonhome discharge, history of COPD, functional dependence, and high preoperative INR values were independent predictors of VTEs, while female sex, no tobacco use, and outpatient surgery were found to be protective factors.