The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis

Mauricio Avila; Sai Krishna Bhogadi; Adam Nelson; Hamidreza Hosseinpour; Michael Ditillo; Malak Akl; Tanya Anand; Audrey L Spencer; Louis J Magnotti; Bellal Joseph

doi:10.1016/j.amjsurg.2022.11.031

The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis

Am J Surg. 2023 Jun;225(6):1086-1090. doi: 10.1016/j.amjsurg.2022.11.031. Epub 2022 Dec 5.

Authors

Affiliations

¹ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: mavilag@arizona.edu.
² Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: saikbhogadi@arizona.edu.
³ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: adamcnelson@arizona.edu.
⁴ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: hosseinpourh@arizona.edu.
⁵ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: mfditillo@arizona.edu.
⁶ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: malakakl@arizona.edu.
⁷ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: tanyaanand@arizona.edu.
⁸ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: audreylspencer@arizona.edu.
⁹ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: lmagnotti@arizona.edu.
¹⁰ Division of Trauma, Critical Care, Burns, and Emergency Surgery, Department of Surgery, College of Medicine, University of Arizona, Tucson, AZ, United States. Electronic address: bjoseph@arizona.edu.

PMID: 36522218
DOI: 10.1016/j.amjsurg.2022.11.031

Abstract

Introduction: Long-term readmission data for venous thromboembolism (VTE) after spinal fractures is limited. We aimed to evaluate the 1-month and 6-month VTE readmission rates in non-operatively managed traumatic spinal fractures.

Methods: Analysis of the 2017 NRD. Adults (≥18 years) with a primary diagnosis of spinal fracture who were managed non-operatively were included. Patients that died on index admission, were on pre-injury anticoagulants, and those with spinal cord injuries were excluded. Outcomes were rates of DVT, PE, and VTE during index admission, and at 1-month and 6-months after discharge. Multivariate regression analysis was performed to identify independent predictors of 6-month readmission with VTE.

Results: 41,337 patients were identified. Mean age was 61 ± 22 years, and the median ISS was 17[9-22]. Vertebral fractures were: 11% sacrococcygeal; 29% lumbar; 19% thoracic; 20% cervical; and 21% multiple levels. During the index admission, 392(0.9%) patients developed DVT, 281(0.7%) developed PE, and 601(1.5%) VTE. Within 1-month of discharge, 177(0.4%) patients were readmitted with DVT, 142(0.3%) with PE, and 268(0.6%) with VTE. Within 6-months of discharge, 352(0.9%) patients were readmitted with DVT, 250(0.6%) with PE, and 513(1.2%) with VTE. Among those who were readmitted within 6-months with VTE, mortality was 6.7%. On multivariate analysis, older age(OR = 1.01,p < 0.01), higher ISS(OR = 1.03,p < 0.001), thoracic level of spinal fracture(OR = 1.37,p = 0.04), and discharge to skilled nursing facility, rehabilitation center, or care facility(OR = 1.73,p < 0.001) were independently associated with 6-month readmission due to VTE.

Conclusions: VTE risk and associated mortality remains high for 6-months after non-operatively managed traumatic spinal fracture. Further studies regarding optimal duration and choice of thromboprophylactic agents are warranted.

Keywords: Adult trauma; Deep venous thrombosis; Long-term outcomes; Non-operative management; Spinal fracture; Venous thromboembolism.

MeSH terms

Adult
Aged
Aged, 80 and over
Anticoagulants / therapeutic use
Fractures, Bone*
Hospitalization
Humans
Middle Aged
Pulmonary Embolism*
Risk Factors
Spinal Fractures* / epidemiology
Spinal Fractures* / therapy
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology
Venous Thromboembolism* / therapy

Substances

Anticoagulants