Venous Thromboembolism in Spinal Fusion Surgery: A Literature Review of Economic Impact, Risk Factors, and Preoperative Management

Abstract

Study Design: Literature Review

Objectives: To conduct a comprehensive literature review about the risk factors and preoperative considerations that are related to postoperative venous thromboembolisms (VTEs) in patients who undergo spinal fusion.

Results: Postoperative VTEs are associated with higher costs and longer hospital stays for patients, in comparison to those who did not develop VTEs. Spinal level and multilevel fusion are risk factors for postoperative VTE. The effect of the surgical approach on VTE risk is unclear. Elevated BMI and age, kidney dysfunction, previous VTE, and primary hypercoagulability are preoperative risk factors for developing VTE. Intraoperative and postoperative risk factors for VTE include prolonged procedure time, discharge to inpatient facilities, and length of hospital stay. The effects of hypertension (HTN), sex, and dural tears on VTE risk in spinal fusion patients are uncertain. Chemoprophylaxis reduced the incidence of VTE. Tranexamic acid was not associated with an increase in VTE postoperatively. The American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator served as a poor predictor of VTE incidence in spinal fusion. Preoperative D-dimer levels may help as a predictive tool.

Conclusions: To elucidate the effects of surgical approach, revision surgery, HTN, and dural tears on postoperative VTE risk, further research is warranted. To help identify high-risk patients, a risk calculator sensitive to VTE must be developed.