Association Between Preoperative D-dimer and Venous Thromboembolism Risk in Patients with Spine Tumors

Retrospective cohort study.

To determine whether preoperative D-dimer predicts perioperative venous thromboembolism (VTE) risk in spine tumor patients.

Venous thromboembolism (VTE) is a common perioperative complication in spine surgery. Though oncologic spine patients are at particularly high risk, few studies have investigated risk factors and screening measures for predicting VTE risk in this population.

Medical records of adult surgical spine tumor patients from January 2021-September 2024 were retrospectively reviewed. Preoperative D-dimer was compared between patients who did and did not develop VTE. Age, sex, tumor type, spinal level, comorbid diabetes, and ambulatory status were assessed as risk factors. Differences between groups were tested using chi-square or Fisher's exact tests for categorical and t-test or Mann-Whitney for continuous variables. Multi-group comparisons by tumor type included adjusted pairwise analyses. Receiver operating characteristic (ROC) curves and area under the curve (AUC) evaluated the diagnostic performance of D-dimer, with optimal threshold determined by Youden Index. Results are presented as means  SD.

Among the 134 patients, deep vein thrombosis (DVT) and pulmonary embolism (PE) incidences were 6.7% and 9.0% respectively. Patients who developed PE had higher D-dimer levels (2,088±2,114 ng/mL) than those who did not (1,222±1,743 ng/mL) (P=0.025). D-dimer was not significantly associated with DVT development. Preoperative D-dimer predicted VTE risk with sensitivity 0.88, negative predictive value 0.97, and AUC 0.67 (95% CI 0.55-0.78). Age, sex, tumor type, spinal level, ambulatory status, and diabetes were not associated with VTE risk.

Preoperative D-dimer is a sensitive but non-specific tool for predicting VTE in spine tumor patients. It may be more useful in predicting PE than DVT and may help guide anticoagulation prophylaxis.