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  • Factors Associated with Venous Thromboembolic Events in Spine Surgery Patients in the Intensive Care Setting: A Single-Institution Experience with 1269 Consecutive Patients

    Final Number:
    114

    Authors:
    Michael Cloney MD; Jack Goergen BS; Benjamin Hopkins BS; Jonathan Tad Yamaguchi BS; Nader S. Dahdaleh MD

    Study Design:
    Clinical Trial

    Subject Category:
    Spine

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2018

    Introduction: Venous thromboembolic events (VTE) are a common cause of morbidity and mortality after spine surgery. Patients admitted to the ICU following spine surgery are a subgroup of patients who are at higher risk of complications, including VTE. We identified factors independently associated with VTE in this unique patient population.

    Methods: We retrospectively analyzed 6869 patients who underwent spine surgery at our institution, of whom 1269 were admitted to the ICU. For ICU patients, we identified demographic, clinical, and procedural factors independently associated with VTE during three time periods: during the ICU admission, after leaving the ICU, at any point during the first 30 postoperative days.

    Results: There was a difference in time-to-VTE based on the type of surgery being performed, with osteotomy patients having a prolonged median time-to-VTE. A history of DVT, PE, and prior IVC filter placement were associated with having a DVT or PE during more than one of the three time periods analyzed. DVT in the ICU was associated with undergoing longer surgeries (OR 1.05, p=0.002), and there was a trend toward significance for fractures (OR 3.09, p=0.051). DVT after leaving the ICU was associated with fusion (OR 0.36, p=0.045) and osteotomy (OR 3.14, p=0.045). PE during the ICU stay was associated with fractures (OR 7.02, p=0.040) and scoliosis correction (OR 7.78, p=0.024). Prophylactic anticoagulation was negatively associated with PE during the ICU stay (OR 0.16, p=0.031). Men were less likely to develop a PE after leaving the ICU (OR 0.12, p=0.006).

    Conclusions: Patients admitted to the ICU following spine surgery are typically in poorer health, and are undergoing high-risk surgeries. Time-to-VTE varies between types of surgeries. Some factors are independently associated with VTE events throughout the 30-day postoperative period, while others are associated with VTE specifically during the ICU stay or after leaving the ICU.

    Patient Care: Identifying and modifying risk factors associated with VTE following ICU admission may improve rates of VTEs following spine surgery

    Learning Objectives: Specific factors are associated with VTE in patients admitted to the ICU following surgery compared to non ICU admission

    References:

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