The following is a summary of “Long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis,” published in the JUNE 2023 issue of Surgery by Avila, et al.

Limited data exist on long-term readmission rates for venous thromboembolism (VTE) after spinal fractures. For a study, researchers sought to evaluate the 1-month and 6-month VTE readmission rates in patients with non-operatively managed traumatic spinal fractures.

The analysis utilized data from the 2017 National Readmission Database (NRD). The study included adults (≥18 years) with a primary diagnosis of spinal fracture managed non-operatively. Patients who died during the index admission were on pre-injury anticoagulants, or had spinal cord injuries were excluded. Deep vein thrombosis (DVT), pulmonary embolism (PE), and overall VTE rates during the initial admission, as well as at 1-month and 6-months after release, were the outcomes that were looked at. Multivariate regression analysis was used to find independent predictors of 6-month readmission with VTE.

A total of 41,337 patients were included in this study, with an average age of 61 ± 22 years and a median Injury Severity Score (ISS) of 17 [9–22]. The distribution of vertebral fractures was as follows: 11% sacrococcygeal, 29% lumbar, 19% thoracic, 20% cervical, and 21% involving multiple levels. During the initial hospital admission, 392 (0.9%) patients developed deep vein thrombosis (DVT), 281 (0.7%) developed pulmonary embolism (PE), and 601 (1.5%) experienced venous thromboembolism (VTE). Within 1 month of discharge, 177 (0.4%) patients were readmitted with DVT, 142 (0.3%) with PE, and 268 (0.6%) with VTE. In the first month after being released, 177 (0.4%), 142 (0.3%), and 268 (0.6%) individuals had DVT, PE, or VTE. Patients were readmitted with DVT, PE, and VTE in 513 (1.2%), 352 (0.9%), and 250 (0.6%) cases within six months of discharge. The death rate was 6.7% among patients readmitted within six months who had VTE. The multivariate analysis revealed that older age (OR = 1.01, P < 0.01), higher ISS (OR = 1.03, P < 0.001), thoracic level of spinal fracture (OR = 1.37, P = 0.04), and discharge to a skilled nursing facility, rehabilitation center, or care facility (OR = 1.73, P < 0.001) were independently associated with 6-month readmission due to VTE. The data sheds light on the importance of long-term VTE risk in non-operatively managed traumatic spinal fractures. Further research is needed to determine the optimal duration and choice of thromboprophylactic agents in this patient population.

VTE and associated mortality risk remained high for six months after non-operatively managed traumatic spinal fractures. Further research was needed to determine the optimal duration and choice of thromboprophylactic agents in the patient population.

Source: americanjournalofsurgery.com/article/S0002-9610(22)00770-X/fulltext