Risk Factors for Venous Thromboembolism Following Lumbar Decompression and Fusion: A Multicenter Analysis

Introduction: Venous thromboembolism (VTE) is a significant postoperative complication in patients undergoing lumbar decompression or fusion surgeries. This study aims to identify and evaluate the risk factors contributing to the development of VTE in patients undergoing lumbar decompression or fusion surgeries.

Methods: The authors queried the institutional registry to identify patients who underwent elective lumbar decompression or fusion for spondylotic pathology between 2019 and 2023 at multiple centers within the same hospital network. Patient demographics, medical histories, intraoperative variables, and postoperative outcomes were collected from medical records. The primary outcome was the incidence of VTE within 30 days postoperatively. The independent Student t-test and Pearson’s chi-square test were mainly performed for univariate analyses of the continuous and categorical variables, respectively. Multivariate logistic regression analysis was performed to identify independent risk factors associated with VTE.

Results: A total of 8,075 and 4,628 patients underwent lumbar decompression and fusion, respectively. The incidences of VTE in patients undergoing lumbar decompression or fusion were 0.51% and 1.10%, respectively. Higher ASA scores (61.0% vs. 39.5%, p< 0.01), BMI (31.83 ± 4.68 vs 29.95 ± 5.68 , p=.037), blood loss (287.44 ± 718.53 vs. 88.042 ± 172.92 ml, p< 0.01), and longer operative time (152.60 ± 100.41 vs. 130.06 ± 60.83 minutes, p=0.018) were associated with higher risk of VTE following lumbar decompression. Higher blood loss (1021.118 ± 1205.964 vs. 517.399 ± 675.069 ml, p< 0.01) and longer operative time (394.64 ± 138.66 vs. 288.14 ± 127.67 minutes, p< 0.01) were also associated with a higher risk of VTE following lumbar fusion. In the multivariate analysis, higher ASA scores and increased blood loss were identified as independent risk factors for VTE following lumbar decompression. In contrast, only increased blood loss was an independent risk factor for VTE following lumbar fusion.

Conclusion : Higher ASA scores and increased blood loss are risk factors for VTE following lumbar spine surgery. This emphasizes the need for targeted VTE prophylactic strategies, particularly for patients with elevated ASA scores and significant intraoperative blood loss.