Thromboembolic Complications Following Spine Surgery Assessed with Spiral CT Scans |
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Authors: | Han Jo Kim MD Sarah Walcott-Sapp BA Ronald S Adler PhD MD Helene Pavlov MD Oheneba Boachie-Adjei MD Geoffrey H Westrich MD |
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Institution: | (1) Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA;(2) Department of Radiology, Hospital for Special Surgery, New York, NY, USA;(3) Weill Cornell Medical College, New York, NY, USA; |
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Abstract: | Spine surgery is associated with a significant risk of postoperative pulmonary embolism (PE) and/or deep vein thrombosis (DVT).
The goal of this study was to determine which symptoms and risk factors were associated with spiral CT scans positive for
PE and/or DVT in the postoperative spine surgery patient. We conducted a retrospective review of all spine patients who underwent
a postoperative CT to rule out PE during the period of March 2004–February 2006. The type of surgical procedure, risk factors,
symptoms prompting scan ordering, anticoagulation, and treatment were recorded. Logistic regression models were used to determine
significant predictors of a positive CT in this patient population. Of the 3,331 patients that had spine surgery during the
study period, 130 (3.9%) had a spiral CT scan to rule out PE and/or proximal DVT. Thirty-three of the 130 (25.4%) CT scans
were positive for PE only, five (3.8%) for PE and DVT, and three (2.3%) for DVT only. Only 24.5% (32) patients had risk factors
for thromboembolic disease, and of these, a history of PE and/or DVT was the only significant risk factor for a positive scan
(p = 0.03). No presenting symptoms or demographic variables were noted to have a significant association with PE and/or DVT.
The type of surgical procedure (i.e., anterior, posterior, and percutaneous) was not associated with an increased risk for
PE and/or DVT. Patients who are undergoing spine surgery with a history of thromboembolic disease should be carefully monitored
postoperatively and may benefit from more aggressive prophylaxis. |
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Keywords: | spine surgery spiral CT thromboembolism |
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