Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism in Patients Undergoing Spinal Fusion for Adult Spinal Deformity

Introduction: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are well-known contributors to morbidity following surgery. Considerable efforts have been invested in reducing PE occurrence through pharmacological and perioperative interventions. However, the effectiveness of these strategies in reducing the incidence and overall mortality associated with pulmonary embolism events remains a matter of debate. Therefore, identifying risky patients has been gaining importance.

Methods: A retrospective cohort study was performed using the 2011-2022 ACS NSQIP database. Adults receiving corrective surgery for adult spinal deformity were identified using CPT and ICD codes. We compared patient demographics, comorbidities, and operation time between those with and without a postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). We used univariable and multivariable logistic regression models to evaluate predictors for DVT/PE occurrence and the impact of DVT/PE on non-routine discharge, 30-day unplanned reoperation, readmission, and mortality.

Results: Among 4,469 patients studied, 143 (3.2%) had a 30-day postoperative occurrence of DVT or PE, 2,775 (62.1%) were female, and 3,661 (81.9%) were non-Hispanic White. On univariable analysis, patient age, BMI, ASA classification 3-4, hypertension, dependent functional status, bleeding disorder, anemia, and total operation time were associated with increased odds of 30-day postoperative DVT or PE. Multivariable analysis revealed age [aOR: 1.03, 95% CI: 1.01-1.04], bleeding disorder [aOR: 2.22, 95% CI: 1.06-4.62], and total operation time [aOR: 1.01, 95% CI: 1.01-1.02] as significant predictors of 30-day postoperative occurrence of DVT or PE. Occurrence of DVT or PE was significantly associated with higher odds of non-routine discharge [OR: 3.15, 95% CI: 2.24-4.44], 30-day unplanned reoperation [OR: 3.06, 95% CI: 1.91-4.91], readmission [OR: 4.42, 95% CI: 2.98-6.56], and mortality [OR: 6.72, 95% CI: 2.74-16.50].

Conclusion : Our study found that patients undergoing corrective surgery for adult spinal deformity are at increased risk for 30-day postoperative DVT or PE with increasing age, bleeding disorder comorbidity, and increased total operation time. These complications significantly impact postoperative outcomes, highlighting the need for targeted prevention strategies.