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Abstract：
Study Design Retrospective clinical study of a prospectively collected, national database. Objective Determine the 30-day incidence, timing, and risk factors for venous thromboembolism (VTE) following thoracolumbar spine surgery. Methods The American College of Surgeons National Surgical Quality Improvement Program Participant Use File identified 43,777 patients who underwent thoracolumbar surgery from 2005 to 2012. Multiple patient characteristics were identified. The incidence and timing (in days) of deep vein thrombosis (DVT) and pulmonary embolus (PE) were determined. Multivariable regression analysis was performed to identify significant risk factors. Results Of the 43,777 patients identified as having had thoracolumbar surgery, 202 cases of PE (0.5%) and 311 cases of DVT (0.7%) were identified. VTE rates were highest in patients undergoing corpectomy, with a 1.7% PE rate and a 3.8% DVT rate. Independent risk factors for VTE included length of stay (LOS) ≥ 6 days (odds ratio [OR] 4.07), disseminated cancer (OR 1.77), white blood cell count > 12 (OR 1.76), paraplegia (OR 1.75), albumin < 3 (OR 1.73), American Society of Anesthesiologists class 4 or greater (OR 1.54), body mass index > 40 (OR 1.49), and operative time > 193 minutes (OR 1.43). LOS < 3 days was protective (OR 0.427). Conclusions We report an overall 30-day PE rate of 0.5% and DVT rate of 0.7% following thoracolumbar spine surgery. Patients undergoing corpectomy were at highest risk for VTE. Multiple VTE risk factors were identified. Further studies are needed to develop algorithms to stratify VTE risk and direct prophylaxis accordingly.
摘要：
研究设计一项前瞻性收集的回顾性临床研究，国家数据库。目的确定30天的发病率，定时,胸腰段脊柱手术后静脉血栓栓塞（VTE）的危险因素。方法美国外科医生协会国家手术质量改进计划参与者使用档案确定了2005年至2012年接受胸腰椎手术的43,777例患者。确定了多个患者特征。确定深静脉血栓形成（DVT）和肺栓塞（PE）的发生率和时间（天）。进行多元回归分析以确定显著的危险因素。结果在43,777例被确定为胸腰椎手术的患者中，结果发现PE202例(0.5%)和DVT311例(0.7%)。VTE发生率最高的患者进行全身切除术，PE率为1.7%，DVT率为3.8%。VTE的独立危险因素包括住院时间（LOS）≥6天（比值比[OR]4.07），播散性癌症（OR1.77），白细胞计数>12（OR1.76），截瘫（OR1.75），白蛋白<3（OR1.73），美国麻醉医师协会4级或以上（OR1.54），体重指数>40（OR1.49），手术时间>193分钟（OR1.43）。LOS<3天是保护性的(OR0.427)。结论我们报告了胸腰椎手术后30天的总体PE率为0.5％，DVT率为0.7％。进行全身切除术的患者发生VTE的风险最高。确定了多个VTE危险因素。需要进一步的研究来开发算法来对VTE风险进行分层并相应地进行预防。
