Risk factors for venous thromboembolism following spinal surgery: A meta-analysis

BACKGROUND: To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery. METHODS: Literature published in PubMed, Embase, the Cochrane Library, and Web of Science was systematically reviewed to assess risk factors for VTE following spinal surgery. The data analysis was conducted with STATA 12.0. Data were pooled using fixed-effects or random-effects models according to the heterogeneity among the included studies. RESULTS: Twenty-six studies involving 3,216,187 patients were included in this meta-analysis, and the total incidence of VTE after spinal surgery was 0.35% (0.15–29.38%). The pooled analysis suggested that the incidence of VTE after spinal surgery was higher in such aspects as increasing age (weighted mean difference [WMD] 0.55 years, 95% confidence interval [CI] 0.33–0.78, P < .001), female sex (odds ratio [OR] 1.12, 95% CI 1.01–1.25; P = .034), diabetes (OR 1.34, 95% CI 1.29–1.44; P < .001), chronic kidney disease (OR = 8.31, 95% CI 1.98–34.93; P = .004), nonambulatory preoperative activity status (OR 3.67, 95% CI 2.75–4.83; P < .001), D-dimer level (WMD 1.023, 95% CI 0.162–1.884; P = .02), long duration of operation (WMD 0.73, 95% CI 0.21–1.24; P = .006), spine fusion (OR 1.54, 95% CI 1.31–1.82; P < .001), and blood transfusion (OR 2.31, 95% CI 1.73–3.07; P < .001), and the differences were statistically significant. However, there were no significant differences in body mass index, obesity, hypertension, coronary heart disease, spondylolisthesis, intraoperative blood loss, surgical procedures (anterior lumbar interbody fusion vs posterior intervertebral fusion /translaminar lumbar interbody fusion), or surgical site (lumbar vs thoracic) (all P > .05). CONCLUSION: Based on our meta-analysis, we identified several important factors that increased the risk of VTE after spinal surgery. We hope our study provides assistance to spine surgeons so that they can adequately analyze and assess risk factors in patients and then develop preventive measures to reduce the incidence of VTE.