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The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis

Avila, Mauricio ; Bhogadi, Sai Krishna ; Nelson, Adam ; Hosseinpour, Hamidreza ; Ditillo, Michael ; Akl, Malak ; Anand, Tanya ; Spencer, Audrey L. ; Magnotti, Louis J. ; Joseph, Bellal

The American journal of surgery, 2023-06, Vol.225 (6), p.1086-1090 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis
Autor: Avila, Mauricio ; Bhogadi, Sai Krishna ; Nelson, Adam ; Hosseinpour, Hamidreza ; Ditillo, Michael ; Akl, Malak ; Anand, Tanya ; Spencer, Audrey L. ; Magnotti, Louis J. ; Joseph, Bellal
Assuntos: Adult ; Adult trauma ; Age ; Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; Chronic obstructive pulmonary disease ; Deep venous thrombosis ; Diabetes ; Disease prevention ; Family income ; Fractures ; Fractures, Bone ; Health care policy ; Hospitalization ; Hospitals ; Humans ; Hypertension ; Injuries ; Long-term outcomes ; Middle Aged ; Mortality ; Multivariate analysis ; Non-operative management ; Patients ; Population ; Pulmonary Embolism ; Pulmonary embolisms ; Regression analysis ; Rehabilitation ; Risk Factors ; Spinal cord injuries ; Spinal fracture ; Spinal Fractures - epidemiology ; Spinal Fractures - therapy ; Thorax ; Thromboembolism ; Thrombosis ; Trauma ; Venous thromboembolism ; Venous Thromboembolism - epidemiology ; Venous Thromboembolism - etiology ; Venous Thromboembolism - therapy ; Vertebrae
É parte de: The American journal of surgery, 2023-06, Vol.225 (6), p.1086-1090
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: Long-term readmission data for venous thromboembolism (VTE) after spinal fractures is limited. We aimed to evaluate the 1-month and 6-month VTE readmission rates in non-operatively managed traumatic spinal fractures. Analysis of the 2017 NRD. Adults (≥18 years) with a primary diagnosis of spinal fracture who were managed non-operatively were included. Patients that died on index admission, were on pre-injury anticoagulants, and those with spinal cord injuries were excluded. Outcomes were rates of DVT, PE, and VTE during index admission, and at 1-month and 6-months after discharge. Multivariate regression analysis was performed to identify independent predictors of 6-month readmission with VTE. 41,337 patients were identified. Mean age was 61 ± 22 years, and the median ISS was 17[9–22]. Vertebral fractures were: 11% sacrococcygeal; 29% lumbar; 19% thoracic; 20% cervical; and 21% multiple levels. During the index admission, 392(0.9%) patients developed DVT, 281(0.7%) developed PE, and 601(1.5%) 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. Within 6-months of discharge, 352(0.9%) patients were readmitted with DVT, 250(0.6%) with PE, and 513(1.2%) with VTE. Among those who were readmitted within 6-months with VTE, mortality was 6.7%. On multivariate analysis, 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 skilled nursing facility, rehabilitation center, or care facility(OR = 1.73,p < 0.001) were independently associated with 6-month readmission due to VTE. VTE risk and associated mortality remains high for 6-months after non-operatively managed traumatic spinal fracture. Further studies regarding optimal duration and choice of thromboprophylactic agents are warranted. •Long-term readmission data for venous thromboembolism (VTE) after spinal fractures is limited.•There is a shift towards non-operative management for stable spinal fractures without evidence of neurologic deficits or SCI.•VTE risk and associated mortality remains high for 6-months after non-operatively managed traumatic spinal fracture.•Further studies regarding optimal duration and choice of thromboprophylactic agents are warranted.
Editor: United States: Elsevier Inc
Idioma: Inglês

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The long-term risks of venous thromboembolism among non-operatively managed spinal fracture patients: A nationwide analysis

Avila, Mauricio ; Bhogadi, Sai Krishna ; Nelson, Adam ; Hosseinpour, Hamidreza ; Ditillo, Michael ; Akl, Malak ; Anand, Tanya ; Spencer, Audrey L. ; Magnotti, Louis J. ; Joseph, Bellal

United States: Elsevier Inc

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