ORIGINAL

Thromboembolism Events After Spine Surgery: a retrospective study of 1280 patients in a European Spine Department

Tromboembolismos após Cirurgia na Coluna Vertebral: um estudo retrospectivo de 1280 pacientes em um Departamento de Coluna Europeu

  • João Carvalho Pereira 1    João Carvalho Pereira 1
  • André Santos-Moreira 1    André Santos-Moreira 1
  • Ana Águas dos Santos 1 2
  • Joana Araújo de Azevedo 1
  • Nuno Oliveira 1    Nuno Oliveira 1
  • Pedro Varanda 1 2    Pedro Varanda 1 2
  • Bruno Direito-Santos 1 2    Bruno Direito-Santos 1 2
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Resumo

Introdução: a verdadeira incidência de Tromboembolia Venosa Profunda (TVP) relacionada com cirurgia da coluna e o perfil da população em risco permanecem temas debatidos, variando entre 0,3% e 31% na literatura. Objetivo: este estudo tem como objetivo avaliar a incidência e estudar os fatores de risco relacionados com a ocorrência de TVP após cirurgia da coluna e estimar o impacto da tromboprofilaxia no desenvolvimento de TVP. Métodos: analisamos retrospectivamente todos os pacientes submetidos a cirurgia da coluna num centro de cirurgia de coluna entre 2015 e 2019, com pelo menos doze meses de acompanhamento. Resultados: foi incluído um total de 1280 pacientes. Dezassete pacientes (1,3%) desenvolveram um evento de TVP no período de acompanhamento. O tempo mediano até o evento foi de 28 dias, com 50% dos eventos de TVP ocorrerendo no primeiro mês. A idade média na altura da cirurgia foi de cinquenta e sete anos. A cirurgia oncológica da coluna (n=2; 11,8%) e os procedimentos que envolveram abordagem anterior e posterior (n=5; 29,4%) revelaram taxas significativamente mais elevadas de TVP (p < 0,05). Entre os eventos tromboembólicos, oito (47,1%) pacientes utilizaram pelo menos um método de tromboprofilaxia. A quimioprofilaxia para TVP não foi associada a uma menor ocorrência de TVP (p= 0,184) e o uso intravenoso de ácido tranexâmico não foi considerado um fator de risco para TVP (p= 0,176). Conclusão: a incidência de TVP após cirurgia da coluna é baixa. A tromboprofilaxia não foi um preditor independente significativo de eventos tromboembólicos no nosso estudo. Idade, sexo e uso intravenoso de ácido tranexâmico não influenciaram a incidência de TVP. São necessários mais estudos com um maior número de pacientes para abordar a relação risco-benefício da tromboprofilaxia. 

Palavras-chave

Cirurgia da coluna; Tromboembolia venosa profunda; Tromboprofilaxia

Abstract

 Introduction: the real incidence of spine surgery related Venous Thromboembolic Event (VTE) and the profile of the population at risk remains a debated topic, ranging from 0.3%-31% in the literature. Objective: this study aims to evaluate the incidence and study the risk factors regarding VTE occurrence after spine surgery and to estimate the impact of thromboprophylaxis on VTE development. Methods: we retrospectively analyzed all patients who underwent spine surgery at spine department between 2015 and 2019 with at least 12-months follow-up. Results: a total of 1280 patients were included. Seventeen patients (1.3%) developed a VTE event in the follow-up period. Median time-to-event was 28 days, with 50% of VTEs occurring in the first month. Mean age-at-surgery was fifty-seven years old. Oncological related spine surgery (n=2; 11.8%) and procedures that involved both anterior and posterior approach (n=5; 29.4%) revealed statistically significant higher rates of VTE (p < 0.05). Among thromboembolic events. eight (47.1%) patients used at least one method of thromboprophylaxis. VTE chemoprophylaxis was not associated with lower VTE occurrence (p= 0.184) and tranexamic acid intravenous use was not found to be a risk factor for VTE (p= 0.176). Conclusion: the incidence of VTE after spine surgery is low. Thromboprophylaxis was not a significant independent predictor of thromboembolic events in our study. Age, sex and tranexamic acid intravenous use did not influence VTE incidence. Further studies with a larger number of patients are needed to address the risk-benefit relationship of thromboprophylaxis.

Keywords

Spine surgery; Venous thromboembolism; Thromboprophylaxis

References

1. Nimmons S, Rizkalla J, Solis J, Dawkins J, Syed I. Design and retrospective application of a spine trauma DVT prophylaxis protocol on level 1 trauma center patient database. Global Spine J. 2022;12(7):1321- 9. http://doi.org/10.1177/2192568220979139. PMid:33877927.

2. Zhang L, Cao H, Chen Y, Jiao G. Risk factors for venous thromboembolism following spinal surgery: a meta-analysis. Medicine. 2020;99(29):e20954. http://doi.org/10.1097/MD.0000000000020954. PMid:32702835.

3. Glotzbecker MP, Bono CM, Wood KB, Harris MB. Thromboembolic disease in spinal surgery: a systematic review. Spine. 2009;34(3):291- 303. http://doi.org/10.1097/BRS.0b013e318195601d. PMid:19179925.

4. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9. http://doi. org/10.1016/j.jclinepi.2007.11.008. PMid:18313558.

5. Schairer WW, Pedtke AC, Hu SS. Venous thromboembolism after spine surgery. Spine. 2014;39(11):911-8. http://doi.org/10.1097/ BRS.0000000000000315. PMid:24718077.

6. Solaru S, Alluri RK, Wang JC, Hah RJ. Venous thromboembolism prophylaxis in elective spine surgery. Global Spine J. 2021;11(7):1148- 55. http://doi.org/10.1177/2192568220962439. PMid:33034229.

7. Ellenbogen Y, Power RG, Martyniuk A, Engels PT, Sharma SV, Kasper EM. Pharmacoprophylaxis for venous thromboembolism in spinal surgery: a systematic review and meta-analysis. World Neurosurg. 2021;150:e144-54. http://doi.org/10.1016/j.wneu.2021.02.120. PMid:33684581.

8. Cox JB, Weaver KJ, Neal DW, Jacob RP, Hoh DJ. Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: clinical article. J Neurosurg Spine. 2014;21(4):677-84. http://doi.org/10.3171/2014.6.SPINE13447. PMid:25105337.

9. Wang T, Yang SD, Huang WZ, Liu FY, Wang H, Ding WY. Factors predicting venous thromboembolism after spine surgery. Medicine. 2016;95(52):e5776. http://doi.org/10.1097/MD.0000000000005776. PMid:28033299.

10. Guo Y, Zou Z, Jia L, Huang Z, Yun X, Xing G. Safety and effectiveness of argatroban versus heparin for preventing venous thromboembolism after lumbar decompressive surgery. Int J Surg. 2017;44:324-8. http:// doi.org/10.1016/j.ijsu.2017.07.031. PMid:28694001.

11. Zeng XJ, Peng H. Prevention of thromboembolic complications after spine surgery by the use of low-molecular-weight heparin. World Neurosurg. 2017;104:856-62. http://doi.org/10.1016/j.wneu.2017.05.050. PMid:28529056.

12. McLynn RP, Diaz-Collado PJ, Ottesen TD, et al. Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery. Spine J. 2018;18(6):970-8. http://doi.org/10.1016/j. spinee.2017.10.013. PMid:29056565.

13. Nazareth A, D’Oro A, Liu JC, et al. Risk factors for postoperative venous thromboembolic events in patients undergoing lumbar spine surgery. Global Spine J. 2019;9(4):409-16. http://doi. org/10.1177/2192568218797094. PMid:31218200.

14. Fiasconaro M, Poeran J, Liu J, Wilson LA, Memtsoudis SG. Venous thromboembolism and prophylaxis therapy after elective spine surgery: a population-based study. Can J Anaesth. 2021;68(3):345-57. http:// doi.org/10.1007/s12630-020-01859-2. PMid:33210220.

15. Lowery A, Patel A, Ames R, Ramsey F, Slattery B, Pazionis T. Prevalence of venous thromboembolism following acute spinal cord injury in an urban inner city hospital. Int J Spine Surg. 2021;15(3):562- 9. http://doi.org/10.14444/8076. PMid:33963036.

16. Kiguchi MM, Schobel H, TenEyck E, et al. The risks and benefits of early venous thromboembolism prophylaxis after elective spinal surgery: a single-centre experience. J Perioper Pract. 2022;32(11):286- 94. http://doi.org/10.1177/17504589211002070. PMid:34301162.

17. Taghlabi K, Carlson BB, Bunch J, Jackson RS, Winfield R, Burton DC. Chemoprophylactic anticoagulation 72 hours after spinal fracture surgical treatment decreases venous thromboembolic events without increasing surgical complications. N Am Spine Soc J. 2022;11:100141. http://doi.org/10.1016/j.xnsj.2022.100141. PMid:35898944.

18. Tracy BM, Dunne JR, O’Neal CM, Clayton E. Venous thromboembolism prophylaxis in neurosurgical trauma patients. J Surg Res. 2016;205(1):221-7. http://doi.org/10.1016/j.jss.2016.06.049. PMid:27621023.

19. Chang R, Scerbo MH, Schmitt KM, et al. Early chemoprophylaxis is associated with decreased venous thromboembolism risk without concomitant increase in intraspinal hematoma expansion after traumatic spinal cord injury. J Trauma Acute Care Surg. 2017;83(6):1088-94. http://doi.org/10.1097/TA.0000000000001675. PMid:28863085.

20. Li X, Jiao G, Li J, et al. Combined use of tranexamic acid and rivaroxaban in posterior/transforaminal lumbar interbody fusion surgeries safely reduces blood loss and incidence of thrombosis: evidence from a prospective, randomized, double-blind, placebo-controlled study. Global Spine J. 2023;13(5):1229-37. http://doi. org/10.1177/21925682211024556. PMid:34569334.

21. Cao Z, Li Q, Guo J, Li Y, Wu J. Optimal administration strategies of tranexamic acid to minimize blood loss during spinal surgery: results of a Bayesian network meta-analysis. Ann Med. 2022;54(1):2053-63. http://doi.org/10.1080/07853890.2022.2101687. PMid:35862264.

22. Jones AR, Williams T, Paringe V, White SP. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study. Injury. 2016;47(2):428-31. http://doi. org/10.1016/j.injury.2015.11.012. PMid:26689495.

23. Schulte LM, O’Brien JR, Bean MC, Pierce TP, Yu WD, Meals C. Deep vein thrombosis and pulmonary embolism after spine surgery: incidence and patient risk factors. Am J Orthop. 2013;42(6):267-70. PMid:23805420.

24. Glotzbecker MP, Bono CM, Harris MB, Brick G, Heary RF, Wood KB. Surgeon practices regarding postoperative thromboembolic prophylaxis after high-risk spinal surgery. Spine. 2008;33(26):2915-21. http://doi. org/10.1097/BRS.0b013e318190702a. PMid:19092624.

25. Kim HJ, Kepler C, Cunningham M, Rawlins B, Boachie-Adjei O. Pulmonary embolism in spine surgery: a comparison of combined anterior/posterior approach versus posterior approach surgery. Spine. 2011;36(2):177-9. http://doi.org/10.1097/BRS.0b013e3181cb4717. PMid:20508550.

26. Piasecki DP, Poynton AR, Mintz DN, et al. Thromboembolic disease after combined anterior/posterior reconstruction for adult spinal deformity: a prospective cohort study using magnetic resonance venography. Spine. 2008;33(6):668-72. http://doi.org/10.1097/ BRS.0b013e318166dfa3. PMid:18344861.



1Orthopedic Surgery and Traumatology Department, Hospital de Braga, Braga, Portugal.

2Life and Health Sciences Research Institute – ICVS, School of Medicine, University of Minho, Braga, Portugal.

 

Received June 23, 2022

Accepted July 28, 2024

JBNC  Brazilian Journal of Neurosurgery

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