The Risk of Venous Thromboembolism after Thoracolumbar Spine Surgery: A Population-Based Cohort Study

Background: Although venous thromboembolism (VTE) is rare, including deep vein thrombosis (DVT) and pulmonary embolism (PE), it is a catastrophic complication after spinal surgery. This study was aimed to investigate the risk factors and incidence of VTE after thoracolumbar spine surgery (TLSS). Methods: We retrieved the data of 8697 patients >20 years old who underwent TLSS between 2000 and 2013 from Taiwan’s Longitudinal Health Insurance Database 2000. Each patient was randomly frequency-matched with four individuals who did not undergo TLSS by age, sex, and index year (the control group). Results: The incidence rates of VTE in the TLSS and control groups were 1.84 and 0.69 per 1000 person-years, respectively. The TLSS group had a higher VTE risk (adjusted HR (aHR): 2.13, 95% confidence interval [95%CI]: 1.41–3.21), DVT (aHR: 2.20, 95%CI: 1.40–3.46), and PE (aHR: 1.60, 95%CI: 0.68–3.78) than the control group. The correlated risk factors of VTE included older age (50–64 years: aHR: 2.16, 95%CI: 1.14–4.09; ≥65 years: aHR: 3.18, 95%CI: 1.65–6.13), a history of cancer (aHR: 2.96, 95%CI: 1.58–5.54), heart failure (aHR: 2.19, 95%CI: 1.27–3.78), and chronic kidney disease (aHR: 1.83, 95%CI: 1.18–2.83). Conclusions: The overall VTE risk following TLSS was less than 2% but correlated with certain risk factors. This information could help the spine surgeon help the patient prevent this fatal complication.