Prevalence And Risk Factors Of Venous Thromboembolism In Patients Undergoing Posterior Expansive Laminoplasty

BackgroundVenous thromboembolism(VTE),a disease that includes pulmonary embolism(PE)and deep venous thrombosis(DVT),is the leading cause of hospital-related deaths in China and other developed countries.The high incidence,mortality,and disability rates of this disease bring enormous economic and social burdens.Current evidence-based medicine and epidemiological data show that VTE is treatable and preventable,and the prophylactic treatment of VTE is far superior to the anticoagulant and thrombolytic therapy after the VTE formation in terms of efficacy and economic benefits.Therefore,prevention of VTE is of crucial importance.Various expert consensus and guidelines on VTE prevention and treatment have currently been published worldwide,effectively reducing the incidence,mortality,and disability rates of this disease.Previous epidemiological surveys have shown that the highest incidence of VTE is observed after orthopedic surgery.The current guidelines for orthopedic VTE,however,have provided recommendations only for the prevention and treatment of VTE in patients undergoing total hip/knee arthroplasty(THA/TKA)and hip fracture surgery(HFS).Spinal surgery is a very high-risk factor for VTE and there is a high incidence of bleeding and postoperative epidural hematoma after prophylactic anticoagulation medications.Evidence-based medical evidence is inadequate to support the effectiveness and risk assessment of various preventive measures currently available,and no international consensus and guidelines for the prevention and treatment of perioperative VTE in spinal surgery have been established yet.Most studies conclude that such physical prevention procedures as early activities and intermittent pneumatic compression(IPC),as well as management of high-risk factors for VTE(smoking,body weight,and blood pressure),can effectively reduce the incidence of VTE after spinal surgery.Therefore,comprehensive and accurate assessments of various risk factors for VTE after spinal surgery,in combination with targeted preventive measures,may effectively reduce the incidence of VTE and optimize the perioperative management of each procedure,thus reducing the incidence of postoperative complications and medical costs.Posterior cervical expansive open-door laminoplasty(PCEOLP)has been widely applied in the treatment of cervical degenerative diseases in recent years with improved neurological functions in long-term follow-up.The main factor for prognosis and mortality is the incidence of postoperative acute VTE.ObjectiveThis study was designed to identify the risk factors for VTE after PCEOLP,provide a reference to further reduce the incidence of VTE,optimize its perioperative management,improve surgical outcomes,and reduce unnecessary medical costs.Patients and MethodsStrict inclusion and exclusion criteria were established and 200 patients who underwent PCEOLP for cervical degenerative diseases between Feb.2016 and Mar.2019 were included in the treatment group.All patients underwent sessions of color Doppler flow imaging(CDFI)on Day 4 and Day 8 after the operation,and those diagnosed with possible PE were examined with CT pulmonary angiography(CTPA).Patients were further divided into the VTE group and non-VTE group according to the presence of VTE.Perioperative management was conducted for all patients in this treatment group.VTE examination and diagnosis were performed by the same experienced team in our hospital.Clinical data of the two groups were retrospectively analyzed and compared to determine the possible risk factors for VTE.ResultsMultivariate logistic analysis showed that old age(P=0.032)and increased D-dimer level on Days 1,4,and 8 after PCEOLP were independent risk factors for postoperative VTE(P=0.027,P=0.014,P<0.001).The ROC curves demonstrated that the area under the curve(AUC)of D-dimer level reached the highest(0.804;95% CI = 0.695-0.913)on Day 8 after the surgery,also showing a high sensitivity(88.9%)and specificity(63.7%)at a D-dimer cutoff value of 1.311 mg/L.ConclusionOld age and increased postoperative D-dimer level are independent risk factors for VTE after PCEOLP,while an increased D-dimer level is of significance for predicting the development of VTE.Cut-off values at different time points in the study provide a reference for predicting the development of VTE and D-dimer levels higher than these values(0.976 mg/L,1.471 mg/L,and 1.311mg/L on Day 1,Day 4,and Day 8 after PCEOLP)indicate a higher probability of VTE.