Pre-operative D-dimer Predicts Pulmonary Embolism Risk in Patients with Spine Tumors

Introduction: Pulmonary embolism (PE) is a life-threatening complication of neurosurgical procedures. Elevated D-dimer has been associated with increased clot risk in various diseases. Though they are a population at particular risk, few studies have investigated the incidence and risk factors for PE in patients with spine tumors. This study examined the incidence of peri-operative PE and assessed whether D-dimer is predictive of PE risk in spine tumor patients.

Methods: A retrospective review was conducted of adult patients with spine tumors who underwent surgery at an academic hospital from January 2021 to September 2024. The incidence of perioperative PE (within 90 days of surgery) was calculated. D-dimer was compared between patients who developed PE and those who did not. Age, sex, and tumor type, and spinal level of tumor were also assessed as risk factors. Differences between groups were tested using the chi-square test for categorical variables and t-test or Mann-Whitney for continuous variables dependent on distribution. Results are presented as means with SD.

Results: This study included 143 patients. The incidence of peri-operative PE was 9.1%. D-dimer in patients who developed PE (2025 +/- 2037 ng/ml) was significantly higher than that of patients who did not (1268 +/- 1716 ng/ml) (p = 0.03). Additionally, patients who developed PE were more likely to have an elevated D-dimer (>500 ng/ml) (75.4%) than those who did not (24.6%) (p = 0.04). Age, sex, tumor type, and spinal level were not significant predictors of PE risk.

Conclusion : Pre-operative D-dimer may be a useful tool to predict risk of perioperative PE in spine tumor patients having surgery. VTE prophylaxis should be considered in patients with D-dimer above 500 ng/ml, as these patients may be at higher risk for PE.