TY - JOUR
T1 - Predictors of Readmissions and Reoperations Related to Venous Thromboembolic Events After Spine Surgery
T2 - A Single-Institution Experience with 6869 Patients
AU - Cloney, Michael
AU - Dhillon, Ekamjeet S.
AU - Roberts, Helena
AU - Smith, Zachary A.
AU - Koski, Tyler R.
AU - Dahdaleh, Nader S.
PY - 2018/3
Y1 - 2018/3
N2 - Background: Readmission and reoperation are used as hospital and surgeon quality metrics. Venous thromboembolic (VTE) events, including deep vein thrombosis and pulmonary embolism (PE), are a major cause of readmission, morbidity, and mortality after spine surgery. Specific procedural, perioperative, and patient characteristics may be associated with these outcomes. Methods: We retrospectively examined records from 6869 consecutive spine surgeries at our institution. We collected data on patient demographics, surgery, hospital course, and 30-day rates of VTE, readmission, reoperation, and epidural hematoma. Stepwise multivariable logistic regression was used to identify independent predictors of each outcome. Results: Factors associated with VTE within 30 days of surgery include a history of VTE (odds ratio [OR] 3.92 [confidence interval 1.83–8.36], P < 0.001), estimated blood loss (EBL; OR 1.017 [1.005–1.029], P = 0.004), fracture (OR 5.42 [2.09–14.05], P = 0.001), history of PE (OR 4.04 [1.22–13.42], P = 0.023), and transfusion (OR 2.26 [1.07–4.77], P = 0.033). Factors associated with readmission were a history of PE (OR 3.27 [1.07–9.97], P = 0.038), PE (OR 8.07 [2.26–28.8], P = 0.001), transfusion (OR 2.54 [1.55–4.17], P < 0.001), comorbid disease burden (OR 1.35 [1.01–1.80], P = 0.041), and tumor surgery (OR 2.84 [1.32–6.10], P = 0.007). Factors associated with reoperation were EBL (OR 1.024 [1.006–1.042], P = 0.008), transfusion (OR 3.86 [1.38–10.79], P = 0.01), and PE (OR 6.05 [1.03–35.62], P = 0.046). Transfusion was associated with epidural hematoma within 30 days (OR 7.38 [1.37–39.83], P = 0.02). Conclusions: Transfusion and EBL are associated with numerous negative outcomes. Transfusion is an independent predictor of VTE, readmission, reoperation, and epidural hematoma requiring evacuation. Specific pathologies were associated with specific negative outcomes.
AB - Background: Readmission and reoperation are used as hospital and surgeon quality metrics. Venous thromboembolic (VTE) events, including deep vein thrombosis and pulmonary embolism (PE), are a major cause of readmission, morbidity, and mortality after spine surgery. Specific procedural, perioperative, and patient characteristics may be associated with these outcomes. Methods: We retrospectively examined records from 6869 consecutive spine surgeries at our institution. We collected data on patient demographics, surgery, hospital course, and 30-day rates of VTE, readmission, reoperation, and epidural hematoma. Stepwise multivariable logistic regression was used to identify independent predictors of each outcome. Results: Factors associated with VTE within 30 days of surgery include a history of VTE (odds ratio [OR] 3.92 [confidence interval 1.83–8.36], P < 0.001), estimated blood loss (EBL; OR 1.017 [1.005–1.029], P = 0.004), fracture (OR 5.42 [2.09–14.05], P = 0.001), history of PE (OR 4.04 [1.22–13.42], P = 0.023), and transfusion (OR 2.26 [1.07–4.77], P = 0.033). Factors associated with readmission were a history of PE (OR 3.27 [1.07–9.97], P = 0.038), PE (OR 8.07 [2.26–28.8], P = 0.001), transfusion (OR 2.54 [1.55–4.17], P < 0.001), comorbid disease burden (OR 1.35 [1.01–1.80], P = 0.041), and tumor surgery (OR 2.84 [1.32–6.10], P = 0.007). Factors associated with reoperation were EBL (OR 1.024 [1.006–1.042], P = 0.008), transfusion (OR 3.86 [1.38–10.79], P = 0.01), and PE (OR 6.05 [1.03–35.62], P = 0.046). Transfusion was associated with epidural hematoma within 30 days (OR 7.38 [1.37–39.83], P = 0.02). Conclusions: Transfusion and EBL are associated with numerous negative outcomes. Transfusion is an independent predictor of VTE, readmission, reoperation, and epidural hematoma requiring evacuation. Specific pathologies were associated with specific negative outcomes.
KW - Deep vein thrombosis
KW - Epidural hematoma
KW - Pulmonary embolism
KW - Readmission
KW - Reoperation
KW - Spine surgery
KW - Transfusion
KW - Venous thromboembolism
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UR - http://www.scopus.com/inward/citedby.url?scp=85039865711&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2017.11.168
DO - 10.1016/j.wneu.2017.11.168
M3 - Article
C2 - 29229350
AN - SCOPUS:85039865711
SN - 1878-8750
VL - 111
SP - e91-e97
JO - World Neurosurgery
JF - World Neurosurgery
ER -