Pulmonary embolism after major spinal deformity corrective surgery in adults

Abstract

Purpose of study: To determine the incidence of pulmonary embolism (PE) and contributing factors after major spinal deformity corrective surgery in adults. Although pulmonary emboli are known to occur after spinal surgery, there are limited published data on the incidence of PE and its contributing factors following major spinal corrective surgery. Incidence of PE in this patient population has been reported to be as high as 3% to 17%. We report our experience in 417 patients.Methods used: From 1992 to 1999, 417 patients (347 women, 70 men) aged 20 to 87 years, (average, 51 years) underwent spinal deformity corrective surgery (146 primary, 271 revision). Surgical approaches include 23 anterior, 155 posterior, 167 same-day combined and 72 staged combined. All surgeries were performed by the senior author (JPK). Average intraoperative blood loss was 3,100 cc. Comorbidity risk was assessed by ASA score (1, 28; 2, 233; 3, 143; 4, 3; average 2.3). Fusion levels varied as follows: <5, 108; 5 to 10, 192; >10, 107. Prophylaxis included TEDS/SCDS, coumadin, heparin, and low molecular weight heparin. We retrospectively reviewed the patients who had pulmonary emboli on our service and identified possible contributory factors.of findings: the incidence of PE was 2.6% (11 of 417; 2 men, 9 women; aged 26 to 64 years, average, 50 years). Diagnosis by spiral computed tomography or V/Q scan occurred on average on postoperative day 4.4 (range, 1 to 13). Two had prior histories of PE/DVT. Eighty percent were diagnosed on or before post operative day 4. Average INR (2.8) and PTT (3) were elevated at time of diagnosis. Average intraoperative blood loss was 2,700 cc (1,000 to 5,000). Average number of levels was 8.6 (4 to 14). Of the 11, 5 were anterior approaches, 5 were posterior alone and 4 were combined; 7 were revisions. ASA scores averaged 2.6 (range, 2 to 3). Of the 11, 3 died (27%).Relationship between findings and existing knowledge: This is the largest known database of complications to date.Overall significance of findings: the incidence of PE after major spinal corrective surgery in adults is significant. Sex, age, blood loss and revision status were not factors affecting mortality. The majority of PEs were diagnosed early and occurred despite therapeutic laboratory values. The high incidence of mortality in this patient population makes it imperative to further investigate PE in this patient population.Disclosures: No disclosures.Conflict of interest: No conflicts.