Anterior lumbar spine surgery (ALSS) requires mobilization of the great vessels, resulting in a high risk of iatrogenic vascular injury (VI). It remains unclear whether VI is associated with increased risk of postoperative complications and other related adverse outcomes.
The purpose of this study was to (1) assess the incidence of postoperative complications attributable to VI during ALSS, and (2) outcomes secondary to VI such as procedural blood loss, transfusion of blood products, length of stay (LOS), and in hospital mortality.
Retrospective propensity-score matched, case-control study at two academic and three community medical centers, PATIENT SAMPLE: Patients 18 years of age or older, undergoing anterior lumbar spine surgery at two academic tertiary care and three community medical centers between January 1st, 2000 to July 31st, 2019 were included in this analysis.
The primary outcome was the incidence of postoperative complications attributable to VI, such as venous thromboembolism (VTE), compartment syndrome, transfusion reaction, limb ischemia, and reoperations. The secondary outcomes included estimated operative blood loss (milliliter), transfused blood products, LOS (days), and in-hospital mortality.
In total, 1035 patients were identified, of which 75 (7.2%) had. For comparative analyses, the 75 VI patients were paired with 75 comparable non-VI patients by propensity-score matching. The adequacy of the matching was assessed by testing the standardized mean differences (SMD) between VI and non-VI group (>0.25 SMD).
Two patients (2.7%) had VI-related postoperative complications in the studied period, which consisted of two DVTs occurring on day three and seven postoperatively. Both DVTs were located in the distal left common iliac vein (CIV). The VI these patients suffered were to the distal inferior caval vein and the left CIV respectively. Both patients did not develop additional complications in consequence of their DVTs, however, did require systemic anticoagulation and placement of an inferior cava vein filter. There was no statistical difference with the non-VI group where no instances (0%) of postoperative complications were reported (P =0.157). No differences were found in LOS or in hospital mortality between the two groups (P=.157 and P=0.999, respectively). Intraoperative blood loss and blood transfusion were both found to be higher in the VI group in comparison to the non-VI group (650 ml, interquartile range [IQR] 300-1400 vs. 150 ml, IQR 50-425, P=<.001; 0 units, IQR 0-3 vs. 0 units, IQR 0-1, P=0.012, respectively).
This study found a low number of serious postoperative complications related to VI in ALSS. In addition, these complications were not significantly different between the VI and matched non-VI ALSS cohort. Although not significant, the found DVT incidence of 2.7% after VI in ALSS warrants vigilance and preventive measures during the postoperative course of these patients.
Copyright © 2020. Published by Elsevier Inc.