Risk Factors for Deep Vein Thrombosis and Pulmonary Embolism in Patients Undergoing Spinal Surgery for Metastatic Spinal Tumors

Introduction: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are significant causes of morbidity after surgical procedures for metastatic spine tumors. Extensive measures have been undertaken to diminish the risk of PE using pharmacological treatments and perioperative strategies. Despite these efforts, the success of these interventions in lowering the frequency and mortality rates related to PE is still debated. Consequently, there is an increasing focus on identifying patients who are at higher risk.

Methods: We conducted a retrospective cohort study using the 2011-2022 American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to identify adults undergoing laminectomy or corpectomy for extradural spinal tumor metastases. We divided this cohort into those with and without a postoperative deep vein thrombosis (DVT) or pulmonary embolism (PE). We compared patient demographics, comorbidities, and operation time between these groups. 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 1,878 patients studied, 98 (5.2%) had a 30-day postoperative occurrence of DVT or PE, 710 (37.8%) were female, and 1,323 (70.4%) were non-Hispanic White. On univariable analysis, congestive heart failure [OR: 3.94, 95% CI: 1.32-11.82] and total operation time [OR: 1.01, 95% CI: 1.01-1.01] were significantly associated with increased odds of 30-day postoperative DVT or PE. Similarly, multivariable analysis revealed congestive heart failure [OR: 7.40, 95% CI: 1.52-35.90] and total operation time [OR: 1.01, 95% CI: 1.01-1.01] 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: 1.60, 95% CI: 1.06-2.42], 30-day unplanned reoperation [OR: 2.17, 95% CI: 1.12-4.20], and readmission [OR: 5.40, 95% CI: 3.54-8.25] but not significantly associated with mortality [OR: 1.57, 95% CI: 0.87-2.82].

Conclusion : Our study found that patients undergoing spinal surgery for metastatic spinal tumors are at increased risk for 30-day postoperative DVT or PE with congestive heart failure and increased total operation time. These complications significantly impact discharge disposition and 30-day unplanned reoperation and readmission, highlighting the need for targeted prevention strategies.