A study recently published in the Journal of Bone and Joint Surgery examines risk factors for venous thromboembolic events after spinal fusion.
Researchers examined 710,154 patients who underwent spinal fusion in the Nationwide Inpatients Sample database from 2001 to 2010 and identified 3,525 who had VTEs. There were 2,038 cases of deep venous thromboses and 1,739 cases of pulmonary emboli.
Here are five findings from the study:
1. Older patients were more likely to have VTE than younger patients. The average age of patients who reported VTE was 57.6 years, compared with 52.8 years among those who did not have VTE. There were also several comorbidities and procedure-related factors identified as independent risk factors for VTE.
2. Men were more likely than women to have VTE. There were 0.58 percent incidence of VTE among male patients, compared with 0.42 percent among female patients. A study published earlier this year in Spine also found having multiple procedures during hospitalization increased the risk of VTE.
3. Black patients had a higher incidence of VTE than white patients. The VTE incidence was 0.78 percent among black patients, compared to 0.47 percent among white patients. The study published in Spine also found VTE rate was higher for patients undergoing anterior cervical fusion when compared with other approaches in the cervical spine. However, the study also found anterior thoracolumbar and lumbosacral fusion patients to have higher VTE rates when compared with other approaches.
4. Patients who had VTE spent more days on average in the hospital. The VTE group patients spent 18 days in the hospital, compared with 3.94 days for patients without VTE. Among hip and knee surgery patients, administering pharmacologic prophylaxis for VTE is strongly recommended and supported by clinical data, the optimal method for prophylaxis among spinal fusion patients is less recognized, according to a 2012 study.
The study examined spinal fusion patients at 244 United States hospitals and found 26.2 percent gave at least 90 percent of their spinal fusion patients prophylaxis. Around 60 percent of the patients received thromboembolism prophylaxis during their first week after surgery.
5. Total hospital charges were much higher for patients with VTE. Without VTE, the total hospital charges were $66,823 on average for spinal fusion patients; with VTE, the hospital charges were $207,253. If surgeons are able to identify risk factors for VTE and prepare accordingly to reduce VTE among their patients, they could significantly impact the cost of spine care.
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