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European Spine Journal

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Open Access 28-12-2023 | Spinal Surgery | Original Article

Nomogram for predicting venous thromboembolism after spinal surgery

Authors: Wei-qing Kong, Cheng Shao, Yu-kun Du, Jian-yi Li, Jia-le Shao, Hui-qiang Hu, Yang Qu, Yong-ming Xi

Published in: European Spine Journal | Issue 3/2024

Abstract

Purpose

This study aimed to establish a nomogram to predict the risk of venous thromboembolism (VTE), identifying potential risk factors, and providing theoretical basis for prevention of VTE after spinal surgery.

Methods

A retrospective analysis was conducted on 2754 patients who underwent spinal surgery. The general characteristics of the training group were initially screened using univariate logistic analysis, and the LASSO method was used for optimal prediction. Subsequently, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative VTE in the training group, and a nomogram for predict risk of VTE was established. The discrimination, calibration, and clinical usefulness of the nomogram were separately evaluated using the C-index, receiver operating characteristic curve, calibration plot and clinical decision curve, and was validated using data from the validation group finally.

Results

Multivariate logistic regression analysis identified 10 independent risk factors for VTE after spinal surgery. A nomogram was established based on these independent risk factors. The C-index for the training and validation groups indicating high accuracy and stability of the model. The area under the receiver operating characteristic curve indicating excellent discrimination ability; the calibration curves showed outstanding calibration for both the training and validation groups. Decision curve analysis showed the clinical net benefit of using the nomogram could be maximized in the probability threshold range of 0.01–1.

Conclusion

Patients undergoing spinal surgery with elevated D-dimer levels, prolonger surgical, and cervical surgery have higher risk of VTE. The nomogram can provide a theoretical basis for clinicians to prevent VTE.

Lutsey PL, Zakai NA (2023) Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol 20(4):248–262PubMedCrossRef

Bouyer B, Rudnichi A, Dray-Spira R, Zureik M, Coste J (2018) Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients. J Thromb Haemost 16(8):1537–1545PubMedCrossRef

Zuckerman SL, Berven S, Streiff MB, Kerolus M, Buchanan IA, Ha A, Bonfield CM, Buchholz AL, Buchowski JM, Burch S et al (2023) Management of anticoagulation/antiplatelet medication and venous thromboembolism prophylaxis in elective spine surgery: concise clinical recommendations based on a modified Delphi process. Spine (Phila Pa 1976) 48(5):301–309PubMedCrossRef

Pateder DB, Gonzales RA, Kebaish KM, Antezana DF, Cohen DB, Chang JY, Kostuik JP (2008) Pulmonary embolism after adult spinal deformity surgery. Spine 33(3):301–305PubMedCrossRef

Schizas C, Neumayer F, Kosmopoulos V (2008) Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis. Eur Spine J 17(7):970–974PubMedPubMedCentralCrossRef

Senders ZJ, Zussman BM, Maltenfort MG, Sharan AD, Ratliff JK, Harrop JS (2012) The incidence of pulmonary embolism (PE) after spinal fusions. Clin Neurol Neurosurg 114(7):897–901PubMedCrossRef

Oda T, Fuji T, Kato Y, Fujita S, Kanemitsu N (2000) Deep venous thrombosis after posterior spinal surgery. Spine 25(22):2962–2967PubMedCrossRef

Mediouni M, Schlatterer DR, Madry H, Cucchiarini M, Rai B (2018) A review of translational medicine. The future paradigm: how can we connect the orthopedic dots better? Curr Med Res Opin 34(7):1217–1229PubMedCrossRef

Yu C, Zhang Y (2019) Development and validation of prognostic nomogram for young patients with gastric cancer. Ann Transl Med 7(22):641PubMedPubMedCentralCrossRef

10.

Yan X, Huang K, Jia M, Yang J, Zhang P, He Y, Lai J, Chen M, Fan S, Li S et al (2022) Construction and verification of a nomogram predicting the risk of preoperative deep vein thrombosis progression after elective spine surgery. Clin Neurol Neurosurg 222:107439PubMedCrossRef

11.

Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, DeJong MR, Streiff MB, Meissner MH (2018) Ultrasound for lower extremity deep venous thrombosis: multidisciplinary recommendations from the society of radiologists in ultrasound consensus conference. Circulation 137(14):1505–1515PubMedCrossRef

12.

Abdel MP, Meneghini RM, Berry DJ (2021) current practice trends in primary hip and knee arthroplasties among members of the American association of hip and knee surgeons: an update during the COVID-19 pandemic. J Arthroplasty 36(7s):S40-S44.e43PubMedCrossRef

13.

Sauerbrei W, Royston P, Binder H (2007) Selection of important variables and determination of functional form for continuous predictors in multivariable model building. Stat Med 26(30):5512–5528PubMedCrossRef

14.

Pencina MJ, D’Agostino RB (2004) Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med 23(13):2109–2123PubMedCrossRef

15.

Vickers AJ, Cronin AM, Elkin EB, Gonen M (2008) Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers. BMC Med Inform Decis Mak 8:53PubMedPubMedCentralCrossRef

16.

Rockson HB, DiPaola CP, Connolly PJ, Stauff MP (2019) Venous thromboembolism prophylaxis for patients having elective spine surgery: when, why, and how much. J Bone Jt Surg Am 101(13):1220–1229CrossRef

17.

Inoue H, Watanabe H, Okami H, Kimura A, Takeshita K (2018) The rate of venous thromboembolism before and after spine surgery as determined with indirect multidetector CT. JB JS Open Access 3(3):e0015PubMedPubMedCentralCrossRef

18.

Sebastian AS, Currier BL, Kakar S, Nguyen EC, Wagie AE, Habermann ES, Nassr A (2016) Risk factors for venous thromboembolism following thoracolumbar surgery: analysis of 43,777 patients from the American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012. Glob Spine J 6(8):738–743CrossRef

19.

Tominaga H, Setoguchi T, Tanabe F, Kawamura I, Tsuneyoshi Y, Kawabata N, Nagano S, Abematsu M, Yamamoto T, Yone K et al (2015) Risk factors for venous thromboembolism after spine surgery. Medicine (Baltim) 94(5):e466CrossRef

20.

Xin WQ, Xin QQ, Ming HL, Gao YL, Zhao Y, Gao YK, Yang X (2019) Predictable Risk Factors of Spontaneous Venous Thromboembolism in Patients Undergoing Spine Surgery. World Neurosurg 127:451–463PubMedCrossRef

21.

Wang T, Yang SD, Huang WZ, Liu FY, Wang H, Ding WY (2016) Factors predicting venous thromboembolism after spine surgery. Medicine (Baltim) 95(52):e5776CrossRef

22.

Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM (2012) Triggers of hospitalization for venous thromboembolism. Circulation 125(17):2092–2099PubMedPubMedCentralCrossRef

23.

Park SJ, Kim CK, Park YS, Moon YW, Lim SJ, Kim SM (2015) Incidence and factors predicting venous thromboembolism after surgical treatment of fractures below the hip. J Orthop Trauma 29(10):e349-354PubMedCrossRef

24.

Tan L, Qi B, Yu T, Wang C (2016) Incidence and risk factors for venous thromboembolism following surgical treatment of fractures below the hip: a meta-analysis. Int Wound J 13(6):1359–1371PubMedPubMedCentralCrossRef

25.

Gillum RF (1987) Pulmonary embolism and thrombophlebitis in the United States, 1970–1985. Am Heart J 114(5):1262–1264PubMedCrossRef

26.

Masuda K, Chikuda H, Yasunaga H, Hara N, Horiguchi H, Matsuda S, Takeshita K, Kawaguchi H, Nakamura K (2012) Factors affecting the occurrence of pulmonary embolism after spinal surgery: data from the national administrative database in Japan. Spine J 12(11):1029–1034PubMedCrossRef

27.

Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF (2007) Systemic effects of smoking. Chest 131(5):1557–1566PubMedCrossRef

28.

Cui LN, Li N, Fu S, Zhang X, Wang X, Wang RT (2018) Combination of preoperative D-dimer and mean platelet volume predicts postoperative deep venous thrombosis in breast cancer patients. Cancer Biomark 21(4):909–913PubMedCrossRef

29.

Recommendations from the ICM-VTE (2022) Spine. J Bone Joint Surg Am 104(Suppl 1):309–328CrossRef

30.

Li L, Li Z, Huo Y, Yang D, Ding W, Yang S (2019) Time-to-event analyses of lower-limb venous thromboembolism in aged patients undergoing lumbar spine surgery: a retrospective study of 1620 patients. Aging 11(19):8701–8709PubMedPubMedCentralCrossRef

31.

Goz V, McCarthy I, Weinreb JH, Dallas K, Bendo JA, Lafage V, Errico TJ (2014) Venous thromboembolic events after spinal fusion: Which patients are at high risk? J Bone Jt Surg Am 96(11):936–942CrossRef

32.

Zöller B, Li X, Sundquist J, Sundquist K (2012) Risk of pulmonary embolism in patients with autoimmune disorders: a nationwide follow-up study from Sweden. Lancet 379(9812):244–249PubMedCrossRef

33.

Freedman JE, Parker C 3rd, Li L, Perlman JA, Frei B, Ivanov V, Deak LR, Iafrati MD, Folts JD (2001) Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation 103(23):2792–2798PubMedCrossRef

34.

Chen M, Ji M, Chen T, Hong X, Jia Y (2020) Alcohol consumption and risk for venous thromboembolism: a meta-analysis of prospective studies. Front Nutr 7:32PubMedPubMedCentralCrossRef

35.

Sebastian AS, Currier BL, Clarke MJ, Larson D, Huddleston PM 3rd, Nassr A (2016) Thromboembolic disease after cervical spine surgery: a review of 5,405 surgical procedures and matched cohort analysis. Glob Spine J 6(5):465–471CrossRef

36.

Cloney MB, Driscoll CB, Yamaguchi JT, Hopkins B, Dahdaleh NS (2020) Comparison of inpatient versus post-discharge venous thromboembolic events after spinal surgery: a single institution series of 6869 consecutive patients. Clin Neurol Neurosurg 196:105982PubMedCrossRef

37.

Cloney MB, Yamaguchi JT, Dhillon ES, Hopkins B, Smith ZA, Koski TR, Dahdaleh NS (2018) Venous thromboembolism events following spinal fractures: a single center experience. Clin Neurol Neurosurg 174:7–12PubMedCrossRef

38.

Chung WS, Lin CL, Chang SN, Chung HA, Sung FC, Kao CH (2014) Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study. Thromb Res 133(4):579–584PubMedCrossRef

39.

Kröger K, Moerchel C (2019) Acute deep vein thrombosis-modern diagnostics and treatment. Chirurg 90(1):71–84PubMedCrossRef

40.

Stewart LK, Kline JA (2020) Metabolic syndrome increases risk of venous thromboembolism recurrence after acute pulmonary embolism. Ann Am Thorac Soc 17(7):821–828PubMedPubMedCentralCrossRef

41.

Chamberlain AM, Folsom AR, Heckbert SR, Rosamond WD, Cushman M (2008) High-density lipoprotein cholesterol and venous thromboembolism in the Longitudinal Investigation of Thromboembolism Etiology (LITE). Blood 112(7):2675–2680PubMedPubMedCentralCrossRef

42.

Peleg K, Rozenfeld M, Radomislensky I, Novikov I, Freedman LS, Israeli A (2014) Policy encouraging earlier hip fracture surgery can decrease the long-term mortality of elderly patients. Injury 45(7):1085–1090PubMedCrossRef

43.

Sartori M, Cosmi B, Legnani C, Favaretto E, Valdré L, Guazzaloca G, Rodorigo G, Cini M, Palareti G (2012) The Wells rule and D-dimer for the diagnosis of isolated distal deep vein thrombosis. J Thromb Haemost 10(11):2264–2269PubMedCrossRef

44.

Inoue H, Watanabe H, Okami H, Kimura A, Seichi A, Takeshita K (2018) D-dimer predicts pulmonary embolism after low-risk spine surgery. Spine Surg Relat Res 2(2):113–120PubMedPubMedCentralCrossRef

45.

Davies HO, Popplewell M, Singhal R, Smith N, Bradbury AW (2017) Obesity and lower limb venous disease—the epidemic of phlebesity. Phlebology 32(4):227–233PubMedCrossRef

46.

Kepler CK, McKenzie J, Kreitz T, Vaccaro A (2018) Venous thromboembolism prophylaxis in spine surgery. J Am Acad Orthop Surg 26(14):489–500PubMedCrossRef

47.

Oglesby M, Fineberg SJ, Patel AA, Pelton MA, Singh K (2013) The incidence and mortality of thromboembolic events in cervical spine surgery. Spine (Phila Pa 1976) 38(9):E521-527PubMedCrossRef

48.

Ballard JL, Carlson G, Chen J, White J (2014) Anterior thoracolumbar spine exposure: critical review and analysis. Ann Vasc Surg 28(2):465–469PubMedCrossRef

49.

Belmont PJ Jr, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ (2014) Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Jt Surg Am 96(1):20–26CrossRef

50.

Wang TY, Sakamoto JT, Nayar G, Suresh V, Loriaux DB, Desai R, Martin JR, Adogwa O, Moreno J, Bagley CA et al (2015) Independent predictors of 30-day perioperative deep vein thrombosis in 1346 consecutive patients after spine surgery. World Neurosurg 84(6):1605–1612PubMedCrossRef

51.

Huang YQ, Liang CH, He L, Tian J, Liang CS, Chen X, Ma ZL, Liu ZY (2016) Development and validation of a radiomics nomogram for preoperative prediction of lymph node metastasis in colorectal cancer. J Clin Oncol 34(18):2157–2164PubMedCrossRef

Title: Nomogram for predicting venous thromboembolism after spinal surgery
Authors: Wei-qing Kong
Cheng Shao
Yu-kun Du
Jian-yi Li
Jia-le Shao
Hui-qiang Hu
Yang Qu
Yong-ming Xi
Publication date: 28-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Spinal Surgery
Phlebothrombosis
Published in: European Spine Journal / Issue 3/2024
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-023-08043-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Nomogram for predicting venous thromboembolism after spinal surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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