A Meta-analysis of the spontaneous incidence of venous thromboembolism after spine surgery

English Keywords:Spinal surgery  Venous thromboembolism  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the related factors affecting the spontaneous incidence of venous thromboembolism after spinal surgery by Meta-analysis. Methods: A computer-based online search was conducted on the topic of the spontaneous incidence of venous thromboembolism after spinal surgery up to July 31, 2017 in PubMed, Web of Science, EMBASE, the Cochrane Library, Wanfang Database, CNKI and VIP databases and spinal surgery, thromboembolism as key words. The NOS scale was used to evaluate the included research. The following variables were extracted: age, sex, body mass index, surgical procedure, approach and site, duration of surgery, blood loss, hypertension, diabetes, heart disease, D-dimer level and preoperative walking disability. Data analysis was conducted via RevMan 5.3. Results: A total of 22 studies which were scaled from 5 to 8 points by NOS were identified, including 2841542 patients undergoing a spinal surgery and 7557 patients who had venous thromboembolism after spinal surgery. The Meta-analysis showed that compared with the non-VTE patients after spine surgery, there were significantly higher age[WMD=6.05, 95%CI(3.62, 8.48), P＜0.0001], more blood loss[SMD=2.22, 95%CI(1.03, 3.41), P=0.0003] and longer duration of surgery[WMD=59.60, 95%CI(10.27, 108.93), P=0.02] among the VTE patients. Male had a significantly lower incidence of VTE after spine surgery[OR=0.59, 95%CI(0.38, 0.94), P=0.03]. Patients undergoing fusion surgery[OR=1.67, 95%CI(1.40, 1.99), P＜0.00001], patients with a history of hypertension[OR=1.78, 95%CI(1.51, 2.10), P＜0.00001], diabetes[OR=1.48, 95%CI(1.40, 1.57), P＜0.00001] and preoperative walking disability[OR=4.47, 95%CI(4.47, 10.98), P=0.001] had a significantly higher incidence of VTE after spine surgery. However, there were no significant differences in BMI, surgical approach and site, history of heart disease and level of d-dimer(P＞0.05). Conclusions: Higher incidence of postoperative venous thromboembolism is closely related with elder, female, fusion surgery, long duration of surgery, more blood loss and patients with hypertension, diabetes or preoperative walking disability, these should be guard against.