CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(01): 51-58
DOI: 10.4103/ajns.AJNS_279_19
Original Article

Postoperative venous thromboembolism in extramedullary spinal tumors

Anukoon Kaewborisutsakul
Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla
,
Thara Tunthanathip
Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla
,
Pakorn Yuwakosol
Neurological Surgery Unit, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla
,
Srirat Inkate
1   Division of Nursing Services, Faculty of Medicine, Prince of Songkla University, Hat-Yai, Songkhla
,
Sutthiporn Pattharachayakul
2   Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat-Yai, Songkhla
› Author Affiliations

Context: Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), is the fatal complication following spine surgery and the appropriate perioperative prophylaxis is still debated. Aims: The aim of this study is to evaluate the incidence of along with risk factors for postoperative VTE in surgically treated extramedullary spinal tumor patients. Setting and Designs: The study design involves single institute and retrospective cohort study. Subjects and Methods: The cohort database was reviewed between the periods of January 2014 and June 2019. Patients undergoing surgery for spine tumor, extradural tumor, and intradural extramedullary were consecutively collected. Statistical Analysis Used: The incidence of VTE and clinical factors reported to be associated with VTE were identified, and then analyzed with an appropriate Cox regression model. Results: The study identified 103 extramedullary spinal tumor patients. Three patients (2.9%) were diagnosed with a proximal leg DVT, while symptomatic PE did not identify. Risk factors associated with DVT occurrence were as follows: operative time ≥8 h (Hazard ratio [HR] 13.98,P= 0.03) and plasma transfusion (HR 16.38,P= 0.02), whereas plasma transfusion was the only significant factor, after multivariate analysis (HR 11.77,P= 0.05). Conclusions: Patients who underwent surgery for extramedullary spinal tumors showed a 2.9% incidence of DVT. The highest rate of DVT was found in patients who received plasma transfusion. More attention should be paid on perioperative associated factors for intensive prevention coupled with early screening in this group.

Financial support and sponsorship

This study was financially supported by the Faculty of Medicine, Prince of Songkla University, Thailand.




Publication History

Received: 10 September 2019

Accepted: 13 November 2019

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Ciftdemir M, Kaya M, Selcuk E, Yalniz E. Tumors of the spine. World J Orthop 2016;7:109-16.
  • 2 Mechtler LL, Nandigam K. Spinal cord tumors: New views and future directions. Neurol Clin 2013;31:241-68.
  • 3 Ng Z, Ng S, Nga V, Teo K, Lwin S, Ning C, Yeo TT, et al. Intradural spinal tumors-review of postoperative outcomes comparing intramedullary and extramedullary tumors from a single institution's experience. World Neurosurg 2018;109:e229-32.
  • 4 Bhat AR, Kirmani AR, Wani MA, Bhat MH. Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column – Data based on single institutional (Sher-I-Kashmir Institute of Medical Sciences) experience. J Neurosci Rural Pract 2016;7:381-91
  • 5 Brooks FM, Ghatahora A, Brooks MC, Warren H, Price L, Brahmabhatt P, et al. Management of metastatic spinal cord compression: Awareness of NICE guidance. Eur J Orthop Surg Traumatol 2014;24 Suppl 1:S255-9.
  • 6 Samartzis D, Gillis CC, Shih P, O'Toole JE, Fessler RG. Intramedullary spinal cord tumors: Part II-management options and outcomes. Global Spine J 2016;6:176-85.
  • 7 Fridley J, Gokaslan ZL. The evolution of surgical management for vertebral column tumors. J Neurosurg Spine 2019;30:417-23.
  • 8 Guzik G. Surgical treatment in patients with spinal tumors – Differences in surgical strategies and malignancy-associated problems. An analysis of 474 patients. Ortop Traumatol Rehabil 2015;17:229-40.
  • 9 Hussain AK, Vig KS, Cheung ZB, Phan K, Lima MC, Kim JS, et al. The impact of metastatic spinal tumor location on 30-day perioperative mortality and morbidity after surgical decompression. Spine (Phila Pa 1976) 2018;43:E648-55.
  • 10 McLynn RP, Diaz-Collado PJ, Ottesen TD, Ondeck NT, Cui JJ, Bovonratwet P, et al. Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery. Spine J 2018;18:970-8.
  • 11 Kahn SR, Morrison DR, Cohen JM, Emed J, Tagalakis V, Roussin A, et al. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev 2013;4:CD008201.
  • 12 Piper K, Algattas H, DeAndrea-Lazarus IA, Kimmell KT, Li YM, Walter KA, et al. Risk factors associated with venous thromboembolism in patients undergoing spine surgery. J Neurosurg Spine 2017;26:90-6.
  • 13 Wang T, Yang SD, Huang WZ, Liu FY, Wang H, Ding WY. Factors predicting venous thromboembolism after spine surgery. Medicine (Baltimore) 2016;95:e5776.
  • 14 Cloney M, Dhillon ES, Roberts H, Smith ZA, Koski TR, Dahdaleh NS. Predictors of readmissions and reoperations related to venous thromboembolic events after spine surgery: A single-institution experience with 6869 patients. World Neurosurg 2018;111:e91-7.
  • 15 Schulte LM, O'Brien JR, Bean MC, Pierce TP, Yu WD, Meals C. Deep vein thrombosis and pulmonary embolism after spine surgery: Incidence and patient risk factors. Am J Orthop (Belle Mead NJ) 2013;42:267-70.
  • 16 Takahashi H, Yokoyama Y, Iida Y, Terashima F, Hasegawa K, Saito T, et al. Incidence of venous thromboembolism after spine surgery. J Orthop Sci 2012;17:114-7.
  • 17 Tominaga H, Setoguchi T, Tanabe F, Kawamura I, Tsuneyoshi Y, Kawabata N, et al. Risk factors for venous thromboembolism after spine surgery. Medicine (Baltimore) 2015;94:e466.
  • 18 Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr., et al. Prevention of venous thromboembolism. Chest 2001;119:132S-75S.
  • 19 Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA Jr., Wheeler HB, et al. Prevention of venous thromboembolism. Chest 2001;119:132S-75S.
  • 20 Basques BA, Fu MC, Buerba RA, Bohl DD, Golinvaux NS, Grauer JN. Using the ACS-NSQIP to identify factors affecting hospital length of stay after elective posterior lumbar fusion. Spine (Phila Pa 1976) 2014;39:497-502.
  • 21 Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005;51:70-8.
  • 22 Park JH, Lee KE, Yu YM, Park YH, Choi SA. Incidence and risk factors for venous thromboembolism after spine surgery in Korean patients. World Neurosurg 2019;128:e289-307.
  • 23 Mosenthal WP, Landy DC, Boyajian HH, Idowu OA, Shi LL, Ramos E, et al. Thromboprophylaxis in spinal surgery. Spine (Phila Pa 1976) 2018;43:E474-81.
  • 24 Zacharia BE, Kahn S, Bander ED, Cederquist GY, Cope WP, McLaughlin L, et al. Incidence and risk factors for preoperative deep venous thrombosis in 314 consecutive patients undergoing surgery for spinal metastasis. J Neurosurg Spine 2017;27:189-97.
  • 25 Bhimani AD, Denyer S, Esfahani DR, Zakrzewski J, Aguilar TM, Mehta AI. Surgical complications in intradural extramedullary spinal cord tumors – An ACS-NSQIP analysis of spinal cord level and malignancy. World Neurosurg 2018;117:e290-9.
  • 26 Fisahn C, Sanders FH, Moisi M, Page J, Oakes PC, Wingerson M, et al. Descriptive analysis of unplanned readmission and reoperation rates after intradural spinal tumor resection. J Clin Neurosci 2017;38:32-6.
  • 27 Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, et al. Prolonged operative duration is associated with complications: A systematic review and meta-analysis. J Surg Res 2018;229:134-44.
  • 28 Weber M, Benditz A, Woerner M, Weber D, Grifka J, Renkawitz T. Trainee surgeons affect operative time but not outcome in minimally invasive total hip arthroplasty. Sci Rep 2017;7:6152.
  • 29 Douros A, Jobski K, Kollhorst B, Schink T, Garbe E. Risk of venous thromboembolism in cancer patients treated with epoetins or blood transfusions. Br J Clin Pharmacol 2016;82:839-48.
  • 30 Zacharski LR. Hypercoagulability preceding cancer. The iron hypothesis. J Thromb Haemost 2005;3:585-8.
  • 31 Khorana AA, Francis CW, Blumberg N, Culakova E, Refaai MA, Lyman GH. Blood transfusions, thrombosis, and mortality in hospitalized patients with cancer. Arch Intern Med 2008;168:2377-81.
  • 32 Yarranton H, Cohen H, Pavord SR, Benjamin S, Hagger D, Machin SJ. Venous thromboembolism associated with the management of acute thrombotic thrombocytopenic purpura. Br J Haematol 2003;121:778-85.
  • 33 Pandey S, Vyas GN. Adverse effects of plasma transfusion. Transfusion 2012;52 Suppl 1:65S-79S.
  • 34 Karhade AV, Vasudeva VS, Dasenbrock HH, Lu Y, Gormley WB, Groff MW, et al. Thirty-day readmission and reoperation after surgery for spinal tumors: A national surgical quality improvement program analysis. Neurosurg Focus 2016;41:E5.
  • 35 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.