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Deep Vein Thrombosis After Complex Posterior Spine Surgery: Does Staged Surgery Make a Difference?

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Abstract

Study Design

Retrospective review of a prospectively collected database.

Objective

To assess the incidence of deep vein thrombosis (DVT) associated with single- versus multistage posterior-only complex spinal surgeries.

Summary of Background Data

Dividing the physiologic burden of spinal deformity surgery into multiple stages has been suggested as a potential means of reducing perioperative complications. DVT is a worrisome complication owing to its potential to lead to pulmonary embolism. Whether or not staging affects DVT incidence in this population is unknown.

Methods

Consecutive patients undergoing either single- or multistage posterior complex spinal surgeries over a 12-year period at a single institution were eligible. All patients received lower extremity venous duplex ultrasonographic (US) examinations 2 to 4 days postoperatively in the single-stage group and 2 to 4 days postoperatively after each stage in the multistage group. Multivariate logistic regression was used to assess the independent contribution of staging to developing a DVT.

Results

A total of 107 consecutive patients were enrolled—26 underwent multistage surgery and 81 underwent single-stage surgery. The single-stage group was older (63 years vs. 45 years; p < .01) and had a higher Charlson comorbidity index (2.25 ± 1.27 vs. 1.23 ± 1.58; p < .01). More multistage patients had positive US tests than single-stage patients (5 of 26 vs. 6 of 81; 19% vs. 7%;p = .13). Adjusting for all the above-mentioned covariates, a multistage surgery was 8.17 (95% CI 0.35–250.6) times more likely to yield a DVT than a single-stage surgery.

Conclusions

Patients who undergo multistage posterior complex spine surgery are at a high risk for developing a DVT compared to those who undergo single-stage procedures. The difference in DVT incidence may be understated as the multistage group had a lower pre- and intraoperative risk profile with a younger age, lower medical comorbidities, and less per-stage blood loss.

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Authors and Affiliations

  1. The Maryland Spine Center, Mercy Medical Center, 301 St Paul Pl, Baltimore, MD, 21202, USA

    Charles C. Edwards II MD, Noah L. Lessing BS, Lisa Ford PA-C & Charles C. Edwards MD

Authors
  1. Charles C. Edwards II MD
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  2. Noah L. Lessing BS
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  3. Lisa Ford PA-C
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  4. Charles C. Edwards MD
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Corresponding author

Correspondence to Charles C. Edwards II MD.

Additional information

CCE II (reports other from Renovis Surgical, other from Renovis Surgical, outside the submitted work); NLL (none); LF (none); CCE (none).

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Edwards, C.C., Lessing, N.L., Ford, L. et al. Deep Vein Thrombosis After Complex Posterior Spine Surgery: Does Staged Surgery Make a Difference?. Spine Deform 6, 141–147 (2018). https://doi.org/10.1016/j.jspd.2017.08.012

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  • DOI: https://doi.org/10.1016/j.jspd.2017.08.012

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