Nomogram to Assess the Risk of Deep Venous Thrombosis After Posterior Lumbar Fusion: A Retrospective Study

Overview

Journal Global Spine J

Publisher Sage Publications

Date 2024 Oct 11

PMID 39390902

Authors

Xiang Li

Jinlong Ma

Lu Xue

Limin Wang

Guangjun Jiao

Yunzhen Chen

Affiliations

Soon will be listed here.

Abstract

Study Design: Retrospective cohort study.

Objectives: Deep venous thrombosis (DVT) is a common complication following lumbar spine surgery, which can lead to adverse consequences such as venous thromboembolism and pulmonary embolism. This study aimed to investigate whether predictors of DVT can improve clinical interventions.

Methods: The study included patients who underwent posterior lumbar fusion between 2012 and 2022. In the training cohort, stepwise logistic regression, based on the Akaike information criterion minimum, was used to identify variables for constructing the nomogram. The nomogram was evaluated and validated using calibration curves, Brier scores, receiver operating characteristic (ROC) curves, C-index, decision curve analyses (DCAs), clinical impact curves (CICs), and risk stratification analyses.

Results: A total of 9216 patients were enrolled after screening. The nomogram included seven variables: cerebrovascular disease, diabetes, body mass index, age, pedicular screw quantity, D-dimer, and hypertension. Calibration plots demonstrated favorable agreement between predicted and observed probabilities. The C-index indicated satisfactory discriminatory ability of the nomogram (0.772 for the training cohort and 0.792 for the validation cohort). Additionally, the DCA and CIC revealed that the nomogram could provide clinical benefits for patients.

Conclusions: This study successfully developed and validated a nomogram that can assess the risk of DVT following posterior lumbar fusion. The nomogram will assist surgeons in making informed clinical decisions.

References

Phillippe H . Overview of venous thromboembolism. Am J Manag Care. 2018; 23(20 Suppl):S376-S382. View

Klaassen Z, Wallis C, Lavallee L, Violette P . Perioperative venous thromboembolism prophylaxis in prostate cancer surgery. World J Urol. 2019; 38(3):593-600. DOI: 10.1007/s00345-019-02705-x. View

Guzman J, Iatridis J, Skovrlj B, Cutler H, Hecht A, Qureshi S . Outcomes and complications of diabetes mellitus on patients undergoing degenerative lumbar spine surgery. Spine (Phila Pa 1976). 2014; 39(19):1596-604. PMC: 4149698. DOI: 10.1097/BRS.0000000000000482. View

Bartlett M, Mauck K, Stephenson C, Ganesh R, Daniels P . Perioperative Venous Thromboembolism Prophylaxis. Mayo Clin Proc. 2020; 95(12):2775-2798. DOI: 10.1016/j.mayocp.2020.06.015. View

Rinde L, Smabrekke B, Mathiesen E, Lochen M, Njolstad I, Hald E . Ischemic Stroke and Risk of Venous Thromboembolism in the General Population: The Tromsø Study. J Am Heart Assoc. 2016; 5(11). PMC: 5210332. DOI: 10.1161/JAHA.116.004311. View

Zhang L, Cao H, Chen Y, Jiao G . Risk factors for venous thromboembolism following spinal surgery: A meta-analysis. Medicine (Baltimore). 2020; 99(29):e20954. PMC: 7373537. DOI: 10.1097/MD.0000000000020954. View

Yamaguchi J, Weiss H, Garcia R, Driscoll C, Stein E, Hopkins B . Trends in national utilization of posterior lumbar fusion and 30-day reoperation and readmission rates from 2006-2016. Clin Neurol Neurosurg. 2020; 199:106310. DOI: 10.1016/j.clineuro.2020.106310. View

Tsimerman G, Roguin A, Bachar A, Melamed E, Brenner B, Aharon A . Involvement of microparticles in diabetic vascular complications. Thromb Haemost. 2011; 106(2):310-21. DOI: 10.1160/TH10-11-0712. View

Golinvaux N, Varthi A, Bohl D, Basques B, Grauer J . Complication rates following elective lumbar fusion in patients with diabetes: insulin dependence makes the difference. Spine (Phila Pa 1976). 2014; 39(21):1809-16. DOI: 10.1097/BRS.0000000000000506. View

10.

Wilson L, Fiasconaro M, Liu J, Bekeris J, Poeran J, Kim D . Trends in Comorbidities and Complications Among Patients Undergoing Inpatient Spine Surgery. Spine (Phila Pa 1976). 2019; 45(18):1299-1308. DOI: 10.1097/BRS.0000000000003280. View

11.

Balachandran V, Gonen M, Smith J, DeMatteo R . Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015; 16(4):e173-80. PMC: 4465353. DOI: 10.1016/S1470-2045(14)71116-7. View

12.

Cheng X, Zhou L, Liu W, Li Y, Peng M, Wang Y . Construction and Verification of Risk Predicting Models to Evaluate the Possibility of Venous Thromboembolism After Robot-Assisted Radical Prostatectomy. Ann Surg Oncol. 2022; 29(8):5297-5306. PMC: 9246795. DOI: 10.1245/s10434-022-11574-5. View

13.

Angraal S, Mortazavi B, Gupta A, Khera R, Ahmad T, Desai N . Machine Learning Prediction of Mortality and Hospitalization in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail. 2019; 8(1):12-21. DOI: 10.1016/j.jchf.2019.06.013. View

14.

Bell E, Agarwal S, Cushman M, Heckbert S, Lutsey P, Folsom A . Orthostatic Hypotension and Risk of Venous Thromboembolism in 2 Cohort Studies. Am J Hypertens. 2015; 29(5):634-40. PMC: 5014082. DOI: 10.1093/ajh/hpv151. View

15.

Kahn S, Morrison D, Diendere G, Piche A, Filion K, Klil-Drori A . Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism. Cochrane Database Syst Rev. 2018; 4:CD008201. PMC: 6747554. DOI: 10.1002/14651858.CD008201.pub3. View

16.

Weber B, Seal A, McGirr J, Fielding K . Case series of elective instrumented posterior lumbar spinal fusions demonstrating a low incidence of venous thromboembolism. ANZ J Surg. 2014; 86(10):796-800. DOI: 10.1111/ans.12702. View

17.

Allman-Farinelli M . Obesity and venous thrombosis: a review. Semin Thromb Hemost. 2011; 37(8):903-7. DOI: 10.1055/s-0031-1297369. View

18.

Gregson J, Kaptoge S, Bolton T, Pennells L, Willeit P, Burgess S . Cardiovascular Risk Factors Associated With Venous Thromboembolism. JAMA Cardiol. 2019; 4(2):163-173. PMC: 6386140. DOI: 10.1001/jamacardio.2018.4537. View

19.

Wei J, Li W, Pei Y, Shen Y, Li J . Clinical analysis of preoperative risk factors for the incidence of deep venous thromboembolism in patients undergoing posterior lumbar interbody fusion. J Orthop Surg Res. 2016; 11(1):68. PMC: 4907081. DOI: 10.1186/s13018-016-0403-0. View

20.

Kakkar A, Cohen A, Tapson V, Bergmann J, Goldhaber S, Deslandes B . Venous thromboembolism risk and prophylaxis in the acute care hospital setting (ENDORSE survey): findings in surgical patients. Ann Surg. 2010; 251(2):330-8. DOI: 10.1097/SLA.0b013e3181c0e58f. View