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. 2023 Feb 1;36(1):E35-E39.
doi: 10.1097/BSD.0000000000001353. Epub 2022 Jun 13.

Venous Thromboembolic Events are Exceedingly Rare in Spinal Fusion for Adolescent Idiopathic Scoliosis

Theodore N Rudic  1 , Thomas E Moran  2 , Pramod N Kamalapathy  2 , Brian C Werner  2 , Keith R Bachmann  2
Affiliations

Venous Thromboembolic Events are Exceedingly Rare in Spinal Fusion for Adolescent Idiopathic Scoliosis

Theodore N Rudic et al. Clin Spine Surg. .

Abstract

Study design: Review of health care record database and determination of population statistics.

Objective: The purpose of this study was to quantify the incidence of clinically significant venous thromboembolic (VTE) events in patients undergoing spinal fusion surgery for adolescent idiopathic scoliosis (AIS) and to identify risk factors for VTE.

Summary of background data: VTE is a serious complication that can cause disability and even death following surgery. Incidence of VTE following AIS surgery has not been well studied; the use of a national database allows the assessment of rare, yet important complications.

Materials and methods: The PearlDiver Database was used to identify AIS patients who underwent primary instrumented spinal fusion between 2010 and 2020. Patient records were cross-referenced for documented VTEs within 30 and 90 postoperative days. Patients with nonidiopathic scoliosis were excluded. Logistic regression was used to evaluate risk factors for correlation with VTE events.

Results: Thirty-eight of 11,775 (0.323%) patients undergoing surgery for AIS developed a VTE complication within 90 postoperative days. Hypercoagulability [odds ratio (OR)=13.50, P <0.0001], spinal fusion involving 13+ vertebral levels (OR=2.61, P <0.0001), obesity (OR=1.30, P <0.005), and older (15-18 y) compared with younger adolescence (10-14 y) (OR=2.12, P <0.0001) were associated with VTE. Seven of 38 (18.4%) patients with a diagnosed thrombophilia experienced VTE.

Conclusions: The incidence of clinically significant VTEs in pediatric patients following spinal fusion surgery for AIS is low with an incidence of 0.323%. Postoperative chemoprophylaxis in the general pediatric population is not indicated. Patients with obesity, those undergoing spinal fusion of 13 or more vertebrae, and adolescents 15-18 years old were found to have higher but still small risk of VTE following surgery. Further prospective studies are needed to validate the risk profile of patients with hypercoagulability and establish clinical guidelines for use of postoperative chemoprophylaxis in this cohort.

Level of evidence: Level III.

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Conflict of interest statement

B.C.W. is a paid consultant, paid presenter or speaker, and receives research support from Arthrex, Inc. He also receives research support from Biomet, Exactech, and Flexion Therapeutics. K.R.B. is a paid consultant for Depuy Synthes Spine and Stryker Spine. The remaining authors declare no conflict of interest.

References

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