Spine surgery for metastases yielded high risk for venous thromboembolism
Patients who underwent spine surgery for treatment of metastases had a high risk of developing both symptomatic and fatal pulmonary embolism, according to results.
Joseph H. Schwab, MD, and colleagues assessed the development of symptomatic venous thromboembolism (VTE), defined as any symptomatic pulmonary embolism (PE) or symptomatic deep venous thromboembolism (DVT) within 90 days of surgery, in 637 patients who underwent spine surgery for treatment of cervical, thoracic or lumbar metastases between 2002 and 2014. Patients received 40 mg of enoxaparin or 5,000 IUs subcutaneous heparin every 12 hours, and researchers started patients on chemoprophylaxis 48 hours after surgery which was continued day to day unless a bleeding complication developed. In addition to assessing the development of symptomatic VTE, researchers also identified any documented wound complication within 90 days of surgery that might be attributed to chemoprophylaxis.
Results showed 11% of patients had symptomatic VTE, with 6% of patients developing PE, of which 1.3% were fatal, and 6% of patients developing DVT. Researchers found an independent association between longer duration of surgery with an increased risk of symptomatic VTE after controlling for age, the modified Charlson Comorbidity Index (CCI), visceral metastases and chemoprophylaxis. Patients with symptomatic VTE had a worse 1-year survival rate after controlling for age, modified CCI , visceral metastases and primary tumor type, according to results. After controlling for relevant confounding variables, researchers noted no association between wound complications and the use of chemoprophylaxis. Overall, results showed 10% of patients developed a wound complication, including 1.1% spinal epidural hematomas.
“The risk of symptomatic VTE is much higher than most people realize. In fact, the risk of fatal pulmonary embolism was 1.3%. Furthermore, those patients that did develop symptomatic thromboembolus had a worse 1-year survival even after controlling for age, Charlson Comorbidity [Index] and primary tumor type,” Schwab told Healio Orthopedics. “The risk of developing a symptomatic thromboembolus persisted even after 6 weeks from the time of surgery. One wonders whether chemical DVT prophylaxis should be continued for a longer period of time in this patient population. It is unclear if this approach would improve survival.” – by Casey Tingle
Reference:
Groot OQ, et al. ePaper 515. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Schwab reports he is a board or committee member for the Association of Bone and Joint Surgeons, the Musculoskeletal Tumor Society and the North American Spine Society; and is a paid presenter or speaker for Stryker.
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Groot OQ, et al. ePaper 515. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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