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  • Incidence and Risk Factors for Preoperative Deep Venous Thrombosis in 314 Consecutive Patients Undergoing Surgery for Spinal Metastasis

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    Sweena Kahn BS, MS; Brad E. Zacharia MD MS; Gustav Y Cederquist; Evan D Bander; William P. Cope; Anne Reiner; Alexa L. Hijazi; Ilya Laufer, MD; Mark H. Bilsky MD

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    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Patients with metastatic spinal disease (MSD) are at heightened risk for development of venous thromboembolic (VTE) complications. Given their a priori risk, preoperative screening with lower extremity Doppler-ultrasonography prior to surgical intervention may be warranted. However, the true incidence and risk factors for deep venous thrombosis (DVT) in this group have not been well-characterized. To this end, we present our series of consecutive patients undergoing surgical management for spinal metastases.

    Methods: A consecutive series of patients who underwent surgery for spinal metastases between 2012 and 2014 at Memorial Sloan Kettering Cancer Center was retrospectively reviewed. Demographic data, preoperative laboratory values and comorbidities, ambulatory status, tumor characteristics including histopathologic classification, and surgical details were analyzed. Univariate analyses were performed.

    Results: We identified 314 patients of whom 234 (74.5%) were screened pre-operatively for a DVT. Of those screened, 23 (10%) were diagnosed with a DVT. The screened patients were slightly older (60.1 vs. 53.2 years, p=0.0008), but otherwise similar in baseline characteristics. Ambulatory status, partial thromboplastin time, and hemoglobin level were statistically associated with screening positive for a DVT. While only 6.8% of ambulatory patients screened positive, 24.4% of non-ambulatory patients did for an odds ratio of 4.39 (95%CI 1.77-10.89). All of the patients who screened positive underwent placement of an inferior vena cava filter.

    Conclusions: Patients with spinal metastases represent a population with unique risks for VTE. We found a 10% incidence of DVT in patients screened preoperatively. The highest rates of preoperative DVT were identified in non-ambulatory patients with a four-fold increase in the likelihood of harboring a DVT. Understanding the preoperative thrombotic status may provide an opportunity for early intervention and risk stratification in this critically ill population.

    Patient Care: No study to date examines the unique risks of venous thromboembolic complications in the spinal oncology patient population. This study offers insight into medical decision making during the preoperative management of patients with metastatic spinal disease.

    Learning Objectives: To identify the incidence and risk factors for preoperative deep venous thrombosis in patients undergoing surgery for metastatic spinal disease.


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