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Deep Vein Thrombosis After Complex Posterior Spine Surgery: Does Staged Surgery Make a Difference?

Charles C Edwards1, Noah L Lessing1, Lisa Ford1

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Multistage posterior complex spinal surgeries increase the risk of deep vein thrombosis (DVT) compared to single-stage procedures. This finding holds despite multistage patients having lower baseline risk factors for DVT.

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Area of Science:

  • Spinal Surgery
  • Vascular Surgery
  • Orthopedic Surgery

Background:

  • Dividing complex spinal deformity surgery into multiple stages may reduce complications.
  • Deep vein thrombosis (DVT) is a significant concern due to its potential for pulmonary embolism.
  • The impact of surgical staging on DVT incidence in posterior-only complex spinal surgeries is not well understood.

Purpose of the Study:

  • To evaluate the incidence of deep vein thrombosis (DVT) in patients undergoing single-stage versus multistage posterior-only complex spinal surgeries.
  • To determine if surgical staging influences DVT risk in this patient population.

Main Methods:

  • Retrospective review of a prospectively collected database of 107 patients undergoing posterior-only complex spinal surgery.
  • Patients were categorized into single-stage (n=81) and multistage (n=26) groups.
  • Lower extremity venous duplex ultrasonography was performed postoperatively, and multivariate logistic regression analyzed DVT risk associated with staging.

Main Results:

  • Multistage surgery was associated with a higher incidence of DVT (19% vs. 7%), though not statistically significant (p=0.13).
  • Multistage patients were younger (45 vs. 63 years) and had fewer comorbidities (Charlson index 1.23 vs. 2.25) than single-stage patients.
  • Multivariate analysis indicated that multistage surgery was 8.17 times more likely to result in DVT, adjusting for covariates.

Conclusions:

  • Patients undergoing multistage posterior complex spine surgery face a significantly higher risk of DVT compared to those undergoing single-stage procedures.
  • The observed difference in DVT incidence may be underestimated due to the lower baseline risk profile of the multistage group.
  • Staging of complex posterior spinal surgeries warrants careful consideration regarding DVT prophylaxis.