Tummala Sri, Chavarria Joseph, Alder Jason, Avramis Ioannis, Rizkalla James M
Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, TX, USA.
Texas A&M College of Medicine, Dallas, Texas, USA.
J Orthop. 2025 May 29;68:191-196. doi: 10.1016/j.jor.2025.05.063. eCollection 2025 Oct.
Level of Evidence: Therapeutic Level III.
Aspirin is commonly used for VTE prophylaxis in orthopedic procedures due to its safety and cost-effectiveness. However, its association with thromboembolic outcomes in obese and morbidly obese patients undergoing LSS remains unclear, particularly in the absence of BMI-specific prophylaxis guidelines. This study evaluates whether venous thromboembolism (VTE) event rates differ by body mass index (BMI) category in patients undergoing lumbar spine surgery (LSS) treated with aspirin monotherapy.
This retrospective cohort study leveraged the TriNetX database to identify adults undergoing LSS who received aspirin monotherapy. Patients were stratified by BMI into non-obese (<30 kg/m) and obese (≥30 kg/m) cohorts. After 1:1 propensity score matching, 23,139 patients were included in each group. A secondary analysis compared obese (BMI 30-39.9) and morbidly obese (≥40) subgroups. Outcomes included incidence of DVT and PE at 90 and 180 days, along with secondary complications such as hematoma and myocardial infarction.
Obese patients had higher observed rates of 90-day DVT (RR: 1.23, 95 % CI: 1.02-1.48) and PE (RR: 1.45, 95 % CI: 1.14-1.84) compared to non-obese patients. At 180 days, PE risk remained elevated (RR: 1.27, 95 % CI: 1.03-1.57), while DVT risk was no longer statistically significant. Morbidly obese patients had a higher 180-day PE risk than the obese group (RR: 1.54, 95 % CI: 1.03-2.29). No significant differences were observed in hematoma or myocardial infarction across groups.
Among patients undergoing LSS with aspirin monotherapy, PE risk remained elevated in obese and especially morbidly obese patients at 180 days, despite matched baseline characteristics. While differences were statistically significant, absolute risk increases were modest. These findings support the need for prospective studies to evaluate whether weight-adjusted dosing, alternative agents, or adjunctive mechanical prophylaxis may offer improved protection in high-BMI populations.
证据级别：治疗性三级。
由于阿司匹林的安全性和成本效益，其常用于骨科手术中的静脉血栓栓塞（VTE）预防。然而，在接受腰椎后路脊柱手术（LSS）的肥胖和病态肥胖患者中，其与血栓栓塞结局的关联仍不明确，尤其是在缺乏针对体重指数（BMI）的预防指南的情况下。本研究评估接受阿司匹林单药治疗的腰椎脊柱手术（LSS）患者中，静脉血栓栓塞（VTE）事件发生率是否因体重指数（BMI）类别而异。
这项回顾性队列研究利用TriNetX数据库识别接受阿司匹林单药治疗的LSS成年患者。患者按BMI分层为非肥胖（<30 kg/m²）和肥胖（≥30 kg/m²）队列。在1:1倾向评分匹配后，每组纳入23139例患者。一项二次分析比较了肥胖（BMI 30 - 39.9）和病态肥胖（≥40）亚组。结局包括90天和180天时深静脉血栓形成（DVT）和肺栓塞（PE）的发生率，以及血肿和心肌梗死等次要并发症。
与非肥胖患者相比，肥胖患者90天时DVT（风险比：1.23，95%置信区间：1.02 - 1.48）和PE（风险比：1.45，95%置信区间：1.14 - 1.84）的观察发生率更高。在180天时，PE风险仍然升高（风险比：1.27，95%置信区间：1.03 - 1.57），而DVT风险不再具有统计学意义。病态肥胖患者180天时的PE风险高于肥胖组（风险比：1.54，95%置信区间：1.03 - 2.29）。各组间在血肿或心肌梗死方面未观察到显著差异。
在接受阿司匹林单药治疗的LSS患者中，尽管基线特征匹配，但肥胖尤其是病态肥胖患者在180天时PE风险仍然升高。虽然差异具有统计学意义，但绝对风险增加幅度较小。这些发现支持有必要进行前瞻性研究，以评估体重调整剂量、替代药物或辅助机械预防措施是否能为高BMI人群提供更好的保护。
