Preoperative Lower Extremity Motor Weakness Affects Deep Vein Thrombosis During the Perioperative Period of Lumbar Surgery.

Abstract

Prospective cohort study. The aim of this study was to assess preoperative factors in the development/exacerbation of deep vein thrombosis (DVT) in lumbar surgery and selectively perform lower-extremity venous ultrasonography (US) in patients at risk of perioperative deep vein thrombosis (DVT). DVT is often present before lumbar surgery and also can develop or is exacerbated postoperatively. An elevated d-dimer level is predictive of DVT but not in all patients or during every operative period. The level of the thrombogenic marker soluble fibrin monomer complex (SFMC) peaks early postoperatively. The study enrolled 698 patients (396 males; 12- 91 years [346 patients aged ≥70 years] at surgery) undergoing surgery for lumbar degenerative diseases. Patients with d-dimer levels ≥0.5 μg/mL or with a lower-extremity manual muscle test (MMT) < grade 3 underwent preoperative US. All preoperative DVT-positive patients and patients with SFMC levels ≥20 μg/mL on postoperative day 1 (POD1) underwent US. Patients with pre- and postoperative femoral-vein DVT underwent screening for pulmonary embolism (PE). There were 251 patients with preoperative d-dimer levels ≥ 0.5 μg/mL, including 226 with MMT ≥ grade 3, 38 (16.8%) of whom were DVT-positive on US. In 48 patients with MMT <grade 3, DVT was detected in 16 of 25 patients with d-dimer levels ≥ 0.5 μg/mL (64.0%) and 10 of 23 with d-dimer levels <0.5 μg/mL (43.5%). Postoperatively, 26 of 64 preoperative DVT-positive patients (40.6%) had postoperative exacerbation of DVT; PE occurred in three. Among 100 of 634 preoperative DVT-negative patients, US revealed new DVT in 14 (2.2%) and PE in one. Preoperative DVT and new postoperative DVT were significantly more common in patients aged ≥70 years; postoperative DVT exacerbation was significantly more common in patients aged <70 years. A significantly higher proportion of patients with motor weakness had preoperative DVTs and postoperative exacerbated or new DVTs. Preoperative DVT screening by US is advisable for patients with elevated d-dimer levels, lower extremities with MMT < grade 3, or DVT positivity. Postoperative US is advisable for patients with elevated SFMC levels on POD1.Level of Evidence: 3.