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Subpopulations found to be at greater risk for VTE after lumbar vertebral fracture
CHICAGO — Certain subsets of patients were at higher risk for thromboembolic events after lumbar vertebral fracture based on results of a study, and those patients may require more aggressive prophylaxis strategies.
Andre M. Samuel, BBA, and colleagues used the National Trauma Data Bank Research Data Set between 2011 and 2012 to identify all patients with lumbar vertebral fractures. Using multivariate logistic regression, they sought to determine the factors associated with the occurrence of either deep vein thrombosis or pulmonary embolism. They considered age, associated injuries and the patients’ Injury Severity Score as factors of interest.
“The rate of VTEs [venous thromboembolism] increases in certain subpopulations, such as older patients, those with greater injury severity, and those with greater length of stay,” Samuel said at the Lumbar Spine Research Society Annual Meeting. “There is a need for more aggressive thromboembolism prophylaxis in patients with these risk factors.”
VTEs can be preventable
Samuel and colleagues identified 80,558 patients from the database who had an overall rate of thromboembolic events of 2.8%. VTEs, he noted, are significant sources of morbidity and mortality in trauma patients, and are preventable, in some cases.
In this patient cohort, the most common comorbidities of interest were hypertension and smoking, which were seen at rates of 26% and 15%, respectively. Head injuries were evident in 27% of patients and upper extremity fractures were evident in 22%, based on the data Samuel presented.
The investigators found the VTE rate increased in certain subsets of patients.
Subpopulations at risk
Although the overall rate of thromboembolic events was low after lumbar vertebral fracture, according to Samuel, the investigators round that some risk factors, which included decubitus ulcers, surgical site infections and pneumonia, were associated with an increased risk of events. In fact, when those risk factors were present the rates of thromboembolic events were as higher even after the researchers controlled for the patient’s age, length of stay and injury severity.
The investigators found VTE event rates of 19.5% with decubitus ulcers, 18.1% with surgical site infections, 16.4% with unplanned returns to the operating room, 15.6% with pneumonia and 15% with admissions that were longer than 21 days.
For patients with hypertension, Samuel said there was an increased risk of developing a VTE, but obesity and diabetes were not associated with a statistically significant difference in VTE rates, according to the results.
Aggressive prophylaxis needed
The multivariate analysis showed smoking was consistent with a decreased rate of VTEs in this patient cohort.
“Several associated injuries were found to have higher rates of VTEs, including abdominal injuries, pelvic fractures and lower extremity fractures. Upper extremity fractures, however, were also associated with lower rates of VTEs,” Samuel said.
The increased VTE rates in certain subpopulations of this patient cohort suggests there is a need for more aggressive prophylaxis strategies in the subsets of patients identified in this study, according to the investigators. – by Robert Linnehan
- Reference:
- Samuel AM, et al. Paper #37. Presented at: Lumbar Spine Research Society Annual Meeting; April 9-10, 2015; Chicago.
- For more information:
- Andre M. Samuel, BBA, can be reached at the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 800 Howard Ave., New Haven, CT 06510; email: andre.samuel@yale.edu.
Disclosure: Samuel reports he received financial/material support from the Orthopaedic Trauma Association.