Pulmonary embolism after adult spinal deformity surgery

Study Design. Retrospective review. Objective. To determine the incidence and identify the associated risk factors of pulmonary embolism ( PE) in patients who receive pharmacologic thromboprophylaxis after adult spinal deformity surgery. Summary of Background Data. The risk of PE after adult spinal deformity surgery is reported to be as high as 2.2%. However, the incidence and associated risks of PE in the same patient population who receive postoperative pharmacologic thromboprophylaxis is unknown. Methods. The study included 361 adult patients with spinal deformity who underwent 407 corrective spinal procedures for scoliosis, kyphosis, or kyphoscoliosis. The incidence of PE was determined and compared with a study ( historical control) of similar patients undergoing similar surgery but without postoperative pharmacologic thromboprophylaxis. Their demographic information, American Society of Anesthesiologists score, operative time, surgical approach, surgical complexity, and intraoperative blood loss were also analyzed to determine the presence of associated risk factors. Results. Despite universal pharmacologic thromboprophylaxis, 10 pulmonary emboli ( 2.4%) were diagnosed. Patients undergoing anterior spinal surgery were at a significantly higher risk than those undergoing posterior spinal surgery ( P = 0.024). The right-side anterior approach was also associated with a significantly higher incidence of PE compared with the left-sided anterior approach ( P = 0.018). Although the rate of PE after posterior spinal surgery did not differ from the historical control, the rate of PE after anterior surgery was reduced by 50% compared with the historical control. Age, gender, estimated blood loss, operative time, revision status, and the number of fusion levels were not significant variables for PE. There were 2 epidural hematomas requiring decompression ( 0.48%) and 1 wound hematoma ( 0.24%). Conclusion. Although pharmacologic thromboprophylaxis probably does not have a role after posterior spinal surgery, the data in this study suggest that it does lower the incidence of PE after anterior spinal surgery.