Abstract
Study Design: Retrospective study. Objective: To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. Results: Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates (P =.010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs (P =.078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process (P = 1.00). Conclusion: Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 729-734 |
| Number of pages | 6 |
| Journal | Global Spine Journal |
| Volume | 9 |
| Issue number | 7 |
| DOIs | |
| State | Published - Oct 1 2019 |
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Keywords
- deep vein thrombosis
- degenerative disc disease
- high altitude
- hypercoagulable state
- low altitude
- orthopedic surgery
- peripheral vasculature
- pulmonary embolism
- spinal fusion
- venous thromboembolism
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
- Clinical Neurology
Cite this
High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion. / Donnally, Chester J.; Vakharia, Ajit M.; Sheu, Jonathan I.; Vakharia, Rushabh M.; Damodar, Dhanur; Shenoy, Kartik; Gjolaj, Joseph P.
In: Global Spine Journal, Vol. 9, No. 7, 01.10.2019, p. 729-734.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - High Altitude Is an Independent Risk Factor for Developing a Pulmonary Embolism, but Not a Deep Vein Thrombosis Following a 1- to 2-Level Lumbar Fusion
AU - Donnally, Chester J.
AU - Vakharia, Ajit M.
AU - Sheu, Jonathan I.
AU - Vakharia, Rushabh M.
AU - Damodar, Dhanur
AU - Shenoy, Kartik
AU - Gjolaj, Joseph P.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Study Design: Retrospective study. Objective: To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. Results: Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates (P =.010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs (P =.078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process (P = 1.00). Conclusion: Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.
AB - Study Design: Retrospective study. Objective: To identify if a 1- to 2-level posterior lumbar fusion at higher altitude is an independent risk factor for postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods: A national Medicare database was queried for all patients undergoing 1- to 2-level lumbar fusions from 2005 to 2014. Those with a prior history of DVT, PE, coagulopathy, or peripheral vascular complications were excluded to better isolate altitude as the dependent variable. The groups were matched 1:1 based on age, gender, and comorbidities to limit potential cofounders. Using ZIP codes of the hospitals where the procedure occurred, we separated our patients into high (>4000 feet) and low (<100 feet) altitudes to investigate postoperative rates of DVTs and PEs at 90 days. Results: Compared with lumbar fusions performed at low-altitude centers, patients undergoing the same procedure at high altitude had significantly higher PE rates (P =.010) at 90 days postoperatively, and similar rates of 90-day postoperative DVTs (P =.078). There were no significant differences in age or comorbidities between these cohorts due to our strict matching process (P = 1.00). Conclusion: Spinal fusions performed at altitudes >4000 feet incurred higher PE rates in the first 90 days compared with patients receiving the same surgery at <100 feet but did not incur higher rates of postoperative DVTs.
KW - deep vein thrombosis
KW - degenerative disc disease
KW - high altitude
KW - hypercoagulable state
KW - low altitude
KW - orthopedic surgery
KW - peripheral vasculature
KW - pulmonary embolism
KW - spinal fusion
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85073030555&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85073030555&partnerID=8YFLogxK
U2 - 10.1177/2192568219828349
DO - 10.1177/2192568219828349
M3 - Article
AN - SCOPUS:85073030555
VL - 9
SP - 729
EP - 734
JO - Global Spine Journal
JF - Global Spine Journal
SN - 2192-5682
IS - 7
ER -