Venous thromboembolism and prophylaxis therapy after elective spine surgery: a population-based study
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REPORTS OF ORIGINAL INVESTIGATIONS
Venous thromboembolism and prophylaxis therapy after elective spine surgery: a population-based study Thromboembolie veineuse et traitement prophylactique apre`s une chirurgie non urgente du rachis : une e´tude base´e sur la population Megan Fiasconaro, MS . Jashvant Poeran, MD, PhD . Jiabin Liu, MD, PhD . Lauren A. Wilson, MPH . Stavros G. Memtsoudis, MD, PhD, MBA Received: 14 July 2020 / Revised: 9 September 2020 / Accepted: 9 September 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Currently, there is no generalized consensus regarding perioperative prophylaxis of venous thromboembolism (VTE) in patients undergoing spine surgery. In the absence of large-scale studies, we aimed to use national data to study the association between anticoagulant prophylaxis and VTE in spine surgical patients. Our secondary outcomes were hematoma and blood transfusion. Methods We included anterior cervical discectomy and fusion (ACDF) and posterior lumbar fusion (PLF) cases from 2006 to 2016 recorded in the Premier Healthcare database. Anticoagulant prophylaxis was categorized into aspirin, regular heparin, and low molecular weight heparin given on the day of surgery. Mixed-effects
models measured the association between anticoagulation categories and outcomes. Cohorts were adjusted to reduce the risk of ‘‘confounding by indication’’ and to distinguish between prophylactic and therapeutic use of anticoagulants. We report odds ratios (OR) and Bonferroni-corrected confidence intervals (CI). Results Among 83,839 individuals undergoing ACDF and PLF, 0.45% (n = 374) had a hematoma, 8.1% (n = 6,769) received a blood transfusion, and 0.13% (n = 113) experienced VTE. After adjustment for relevant covariates, prophylactic aspirin (OR, 1.48; CI, 1.17 to 1.86) and regular heparin (OR, 2.01; CI, 1.81 to 2.24) were associated with increased odds of blood transfusion. No detectable differences in the odds of hematoma or VTE were observed for any anticoagulant.
M. Fiasconaro, MS L. A. Wilson, MPH Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
S. G. Memtsoudis, MD, PhD, MBA (&) Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA e-mail: [email protected]
J. Poeran, MD, PhD Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA J. Liu, MD, PhD Department of Anesthesiology, Critical Care, and Pain Management, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA Department of Anesthesiology, Perioperative Medicine and Intensiv
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