The timing of venous thromboembolic events after spine surgery: a single-center experience with 6869 consecutive patients

Abstract

OBJECTIVE Venous thromboembolic events (VTEs), including both deep venous thrombosis (DVT) and pulmonary embolism, are a major cause of morbidity and mortality after spine surgery. Prophylactic anticoagulation, or chemoprophylaxis, can prevent VTE. However, the timing of VTEs after spine surgery and the effect of chemoprophylaxis on VTE timing remain underinvestigated. METHODS The records of 6869 consecutive spine surgeries were retrospectively examined. Data on patient demographics, surgical variables, hospital course, and timing of VTEs were collected. Patients who received chemoprophylaxis were compared with those who did not. Appropriate regression models were used to examine selection for chemoprophylaxis and the timing of VTEs. RESULTS Age (OR 1.037, 95% CI 1.023-1.051; p < 0.001), longer surgery (OR 1.003, 95% CI 1.002-1.004; p < 0.001), history of DVT (OR 1.697, 95% CI 1.038-2.776; p = 0.035), and fusion surgery (OR 1.917, 95% CI 1.356-2.709; p < 0.001) predicted selection for chemoprophylaxis. Chemoprophylaxis patients experienced more VTEs (3.62% vs 2.03% of patients, respectively; p < 0.001), and also required longer hospital stays (5.0 days vs 1.0 days; HR 0.5107; p < 0.0001) and had a greater time to the occurrence of VTE (median 6.8 days vs 3.6 days; HR 0.6847; p = 0.0003). The cumulative incidence of VTEs correlated with the postoperative day in both groups (Spearman r = 0.9746, 95% CI 0.9457-0.9883, and p < 0.0001 for the chemoprophylaxis group; Spearman r = 0.9061, 95% CI 0.8065-0.9557, and p < 0.0001 for the nonchemoprophylaxis group), and the cumulative incidence of VTEs was higher in the nonchemoprophylaxis group throughout the 30-day postoperative period. Cumulative VTE incidence and postoperative day were linearly correlated in the first 2 postoperative weeks (R = 0.9396 and p < 0.0001 for the chemoprophylaxis group; R = 0.8190 and p = 0.0003 for the nonchemoprophylaxis group) and the remainder of the 30-day postoperative period (R = 0.9535 and p < 0.0001 for the chemoprophylaxis group; R = 0.6562 and p = 0.0058 for the nonchemoprophylaxis group), but the linear relationships differ between these 2 postoperative periods (p < 0.0001 for both groups). CONCLUSIONS Anticoagulation reduces the cumulative incidence of VTE after spine surgery. The cumulative incidence of VTEs rises linearly in the first 2 postoperative weeks and then plateaus. Surgeons should consider early initiation of chemoprophylaxis for patients undergoing spine surgery.

Keywords: BMI = body mass index; CPT= Current Procedural Terminology; DVT; DVT = deep venous thrombosis; EBL = estimated blood loss; VTE = venous thromboembolic event; anticoagulation; chemoprophylaxis; deep vein thrombosis; pulmonary embolism; spine surgery; vascular disorders; venous thromboembolism.