What Pushes Thromboembolic Events Rates Up?

A new multicenter study has identified and quantified which factors are most likely to increase the rate of venous thromboembolic events (VTEs) after vertebral fractures. Their study, “Thromboembolic Events After Traumatic Vertebral Fractures: An Analysis of 190,192 Patients,” was published in the September 15, 2018 edition of Spine.

Co-author Andre M. Samuel, M.D., a third-year orthopedic resident at Hospital for Special Surgery in New York explained the study to OTW, “Thromboembolic events are a serious, preventable postoperative complication that is associated with increased mortality, long-term morbidity, and health care costs. However, chemoprophylaxis with spinal injuries and after spine surgery is controversial due to risks for epidural hematoma.”

The researchers identified all patients with vertebral fractures in the American College of Surgeons National Trauma Data Bank Research Data Set (NTDB RDS) from years 2011 and 2012. They found a total of 190,192 vertebral fractures patients. Using a multivariate analysis, they found that inpatient length of stay was most associated with increased VTEs with an odds ratio (OR) of up to 96.60 for length of stay longer than 28 days (compared to 0 – 3 days).

According to Dr. Samuel, “No large cohorts exist describing the rates and risk factors for VTEs after spinal fractures. This new data will help surgeons risk stratify patients for mechanical and chemoprophylaxis.”

“More aggressive prophylaxis measures should be considered for patients with spinal cord injuries, associated abdominal injuries or femur fractures, obesity, cancer history, or an extended hospital length of stay.”

The investigators also found that in the “… study group of over 190,000 patients with vertebral fractures, the overall rate of VTEs was 2.5%. But when patients with complete spinal cord injuries were measures, the rate rose to 8.6% and then to 12.0% in patients with history of cancer.”