Anticoagulation in Elective Spine Cases

Rates of Hematomas Versus Thromboembolic Disease

Dharani Rohit Thota, BA; Carlos A. Bagley, MD; Mazin Al Tamimi, MD; Paul A. Nakonezny, PhD; Michael Van Hal, MD

Disclosures

Spine. 2021;46(13):901-906. 

In This Article

Results

Participant Characteristics

Of the 1776 patients who underwent elective spine surgery within the Institutional cohort (Table 1), 53.72% were males, with a mean age of 66.12 ± 12.65 years, and a mean operative time of 121.56 ± 90.71 minutes. Mean BMI was 29.62 ± 6.07 kg/m2. About 41% had an ASA classification more than or equal to three.

Of the 89,112 patients who underwent elective spine surgery within the NSQIP cohort (Table 2), 47.78% were males, with a mean age of 57.34 ± 14.15 years, and a mean operative time of 149.74 ± 96.90 minutes. Mean BMI was 30.47 ± 6.31 kg/m2. About 41% had an ASA classification more than or equal to three.

Institutional Cohort

There were 1776 propensity-score matched patients who received elective spine surgery in our cohort. There were equal matched cohorts with pharmacological anticoagulation (n = 888) and without pharmacological anticoagulation (n = 888) in the Institutional cohort. The incidence of VTE, PE, and unplanned reoperation for hematoma in this cohort was 0.96%, 0.34%, and 1.13%, respectively. Predicted odds of VTE (OR = 0.894, 95% CI: 0.352–2.266, P = 0.813) and PE (OR = 1.000, 95% CI: 0.226–4.416, P = 1.000) were not significantly different for patients who received elective spine surgery with pharmacological anticoagulation than those without; however, the odds of an unplanned reoperation for hematoma (OR = 7.535, 95% CI: 2.004–28.340, P = 0.002) were greater for those who received elective spine surgery with pharmacological anticoagulation than those without pharmacologic anticoagulation in our institutional cohort. Incidence rates, odds ratios, and relative risks are reported in Table 3.

NSQIP Cohort

There were 89,112 patients in the NSQIP cohort. The incidence of VTE, PE, and unplanned reoperation for hematoma in this cohort was 0.75%, 0.36%, and 2.39%, respectively. Incidence rates are reported in Table 2.

Our institutional findings may not be generalizable to the larger NSQIP population. However, the incidence rate of VTE in all 89,112 patients was 665 (0.75%). The symptomatic PE was 325 in the same NSQIP cohort for a rate of 0.36%. This is very similar to the incidence rates that we found in our institutional cohort 0.34% (see Table 1) which would support our institutional cohort as being a representative of a larger, more generalizable population.

processing....