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Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients
Author(s): ,
B. Bouyer
Affiliations:
French National Agency for Medicines and Health Products Safety, Saint Denis, France. AP‐HP and Paris‐Descartes University, Paris, France. Paris‐Sud University, Paris, France
,
A. Rudnichi
Affiliations:
French National Agency for Medicines and Health Products Safety, Saint Denis, France
,
R. Dray‐Spira
Affiliations:
French National Agency for Medicines and Health Products Safety, Saint Denis, France
,
M. Zureik
Affiliations:
French National Agency for Medicines and Health Products Safety, Saint Denis, France. Versailles Saint‐Quentin‐en‐Yvelines University, Versailles, France
J. Coste
Affiliations:
AP‐HP and Paris‐Descartes University, Paris, France
Correspondence: Joel Coste, Paris‐Descartes University, Department of Biostatistics and Epidemiology, Hôtel Dieu, Place du Parvis Notre Dame, 75004 Paris, France|Tel: + 33 14 234 7931|E‐mail: joel.coste@parisdescartes.fr
ISTH Academy. Coste J. Aug 2, 2018; 227418
Joel Coste
Joel  Coste

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Background
Postoperative venous thromboembolism (VTE) is a severe complication, the risk of which after lumbar spine surgery (LBS) is not precisely known.
Objective
To estimate the incidence of VTE after LBS, and to identify individual and surgical risk factors.
Methods
All patients aged >18 years who underwent LBS in France between 2009 and 2014 were identified. Among 477 024 patients screened, exclusions concerned recent VTE or surgery, and multiple surgeries during the same hospital stay.
Results
In 323 737 patients (mean age 52.9 years, 51.4% male), we observed 2911 events (0.91%) after a median time of 12 days (Q1–Q3: 5–72 days). The multivariate adjusted Cox model showed increased risks associated with age (4% per year of age; 95% confidence interval [CI] 3.8–4.3), obesity (hazard ratio [HR] 1.32, 95% CI 1.18–1.46), active cancer (HR 1.65, 95% CI 1.5–1.82), previous thromboembolism (HR 5.41, 95% CI 4.74–6.17), severe paralysis (HR 1.47, 95% CI 1.17–1.84), renal disease (HR 1.28, 95% CI 1.04–1.6), psychiatric disease (HR 1.21, 95% CI 1.1–1.32), use of antidepressants (HR 1.13, 95% CI 1.03–1.24), use of contraceptives (HR 1.56, 95% CI 1.19–2.03), extended surgery for scoliosis (HR 3.61, 95% CI 2.96–4.4), implantation of pedicular screws with a ‘dose–effect’ association, and an anterior approach (HR 1.97, 95% CI 1.6–2.43) or a combined approach (HR 2.03, 95% CI 1.44–2.84).
Conclusions
The overall VTE risk after LBS is moderate (< 1%) but is widely modulated by several easily identifiable risk factors. The surgical community should be aware of this heterogeneity, adapt prevention according to patients and to the procedure, and use drug prophylaxis in the event of a high risk being present.
Keyword(s)
incidence, risk factors, spine, surgery, thromboembolism
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