The effect of high-normal preoperative international normalized ratios on postoperative outcomes and complications following posterior cervical spine surgery.
Humans
Female
Cervical Vertebrae
/ surgery
Male
Middle Aged
Postoperative Complications
/ etiology
Aged
International Normalized Ratio
Treatment Outcome
Cohort Studies
Blood Transfusion
/ statistics & numerical data
Hematoma
/ etiology
Adult
Retrospective Studies
Preoperative Period
Elective Surgical Procedures
/ adverse effects
Journal
Journal of orthopaedic surgery and research
ISSN: 1749-799X
Titre abrégé: J Orthop Surg Res
Pays: England
ID NLM: 101265112
Informations de publication
Date de publication:
09 Sep 2024
09 Sep 2024
Historique:
received:
02
06
2024
accepted:
19
08
2024
medline:
10
9
2024
pubmed:
10
9
2024
entrez:
9
9
2024
Statut:
epublish
Résumé
Current guidelines recommend that the International Normalized Ratio (INR) be less than 1.5 prior to spine intervention. Recent studies have shown that an INR > 1.25 is associated worse outcomes following anterior cervical surgery. We sought to determine the risk of complications associated with an INR > 1.25 following elective posterior cervical surgery. The American College of Surgeons National Surgical Quality Improvement Program database was queried. Patients undergoing elective posterior cervical surgery from 2012 to 2016 with an INR level within 24 h of surgery were included. Primary outcomes were hematoma requiring surgery, 30-day mortality, and transfusions within 72-hours. There were 815 patients in the INR ≤ 1 cohort (Cohort A), 410 patients in the 1 < INR ≤ 1.25 cohort (Cohort B), and 33 patients in the 1.25 < INR ≤ 1.5 cohort (Cohort C). Cohort C had a higher rate of transfusion (4% Cohort A; 6% Cohort B; 12% Cohort C; p = 0.028) and the rate of mortality within 30 days postoperatively trended toward significance (0.4% Cohort A; 0.5% Cohort B; 3% Cohort C; p = 0.094). There was no significant difference in the rate of postoperative hematoma formation requiring surgery (0.2% Cohort A; 0% Cohort B; 0% Cohort C; p = 0.58). On multivariate analysis, increasing INR was not associated with an increased risk of developing a major complication. An INR > 1.25 but ≤ 1.5 may be safe for posterior cervical surgery. An INR > 1.25 but ≤ 1.5 was associated with a significantly higher rate of transfusions. However, increasing INR was not significantly associated with increased risk of any of the major complications.
Identifiants
pubmed: 39252112
doi: 10.1186/s13018-024-05009-y
pii: 10.1186/s13018-024-05009-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
552Informations de copyright
© 2024. The Author(s).
Références
de Dios E, Heary RF, Lindhagen L, MacDowall A. Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy: a long-term study of a national cohort. Eur Spine J. 2022;31:334–45.
doi: 10.1007/s00586-021-07067-w
pubmed: 34853923
Wadhwa H, Sharma J, Varshneya K, Fatemi P, Nathan J, Medress ZA, et al. Anterior cervical discectomy and Fusion Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy: a National Administrative Database Analysis. World Neurosurg. 2021;152:e738–44.
doi: 10.1016/j.wneu.2021.06.064
pubmed: 34153482
MacDowall A, Skeppholm M, Lindhagen L, Robinson Y, Löfgren H, Michaëlsson K, et al. Artificial disc replacement versus fusion in patients with cervical degenerative disc disease with radiculopathy: 5-year outcomes from the National Swedish Spine Register. J Neurosurg Spine. 2018;30:159–67.
doi: 10.3171/2018.7.SPINE18657
pubmed: 30485205
Janssen ME, Zigler JE, Spivak JM, Delamarter RB, Darden BV, Kopjar B. ProDisc-C total disc replacement Versus Anterior Cervical Discectomy and Fusion for single-level symptomatic cervical disc disease: seven-year follow-up of the Prospective Randomized U.S. Food and Drug Administration Investigational device exemption study. J Bone Joint Surg Am. 2015;97:1738–47.
doi: 10.2106/JBJS.N.01186
pubmed: 26537161
Woods BI, Hilibrand AS. Cervical radiculopathy: epidemiology, etiology, diagnosis, and treatment. J Spinal Disord Tech. 2015;28:E251–259.
doi: 10.1097/BSD.0000000000000284
pubmed: 25985461
Leonardi MA, Zanetti M, Saupe N, Min K. Early postoperative MRI in detecting hematoma and dural compression after lumbar spinal decompression: prospective study of asymptomatic patients in comparison to patients requiring surgical revision. Eur Spine J. 2010;19:2216–22.
doi: 10.1007/s00586-010-1483-x
pubmed: 20556438
pmcid: 2997206
Mirzai H, Eminoglu M, Orguc S. Are drains useful for lumbar disc surgery? A prospective, randomized clinical study. J Spinal Disord Tech. 2006;19:171–7.
doi: 10.1097/01.bsd.0000190560.20872.a7
pubmed: 16770213
Schroeder GD, Hilibrand AS, Arnold PM, Fish DE, Wang JC, Gum JL, et al. Epidural hematoma following cervical spine surgery. Global Spine J. 2017;7:S120–6.
doi: 10.1177/2192568216687754
Omae T, Koh K, Kumemura M, Sakuraba S, Katsuda Y. Perioperative management of patients with atrial fibrillation receiving anticoagulant therapy. J Anesth. 2019;33:551–61.
doi: 10.1007/s00540-019-02653-1
pubmed: 31069541
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines. J Am Coll Cardiol. 2014;63:e57–185.
doi: 10.1016/j.jacc.2014.02.536
pubmed: 24603191
Jacobson AK. Warfarin monitoring: point-of-care INR testing limitations and interpretation of the prothrombin time. J Thromb Thrombolysis. 2008;25:10–1.
doi: 10.1007/s11239-007-0098-5
pubmed: 18008039
Ignjatovic V. Prothrombin time/international normalized ratio. Methods Mol Biol. 2013;992:121–9.
doi: 10.1007/978-1-62703-339-8_9
pubmed: 23546709
Narouze S, Benzon HT, Provenzano D, Buvanendran A, De Andres J, Deer T, et al. Interventional Spine and Pain procedures in patients on Antiplatelet and Anticoagulant medications (Second Edition): guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy. Reg Anesth Pain Med. 2018;43:225–62. the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain.
pubmed: 29278603
Porto GBF, Jeffrey Wessell DO, Alvarado A, Arnold PM, Buchholz AL. Anticoagulation and spine surgery. Global Spine J. 2020;10:S53–64.
doi: 10.1177/2192568219852051
Rudasill SE, Liu J, Kamath AF. Revisiting the international normalized ratio (INR) threshold for complications in primary total knee arthroplasty: an analysis of 21,239 cases. J Bone Joint Surg. 2019;101:514–22.
doi: 10.2106/JBJS.18.00771
pubmed: 30893232
Rudasill SE, Liu J, Kamath AF. Revisiting the international normalized ratio threshold for bleeding risk and mortality in primary total hip arthroplasty: a National Surgical Quality Improvement Program Analysis of 17,567 patients. J Bone Joint Surg Am. 2020;102:52–9.
doi: 10.2106/JBJS.19.00160
pubmed: 31609891
Strony JT, Ahn J, Du JY, Ahn UM, Haase L, Ahn NU. The Effect of High-Normal Preoperative International Normalized Ratios on outcomes and complications after Anterior cervical spine surgery. Orthopedics. 2023;1–7.
Goldstein CL, Bains I, Hurlbert RJ. Symptomatic spinal epidural hematoma after posterior cervical surgery: incidence and risk factors. Spine J. 2015;15:1179–87.
doi: 10.1016/j.spinee.2013.11.043
pubmed: 24316117
Fehlings MG, Smith JS, Kopjar B, Arnold PM, Yoon ST, Vaccaro AR, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine. 2012;16:425–32.
doi: 10.3171/2012.1.SPINE11467
pubmed: 22324802
Fuchshuber PR, Greif W, Tidwell CR, Klemm MS, Frydel C, Wali A, et al. The power of the National Surgical Quality Improvement program–achieving a zero pneumonia rate in general surgery patients. Perm J. 2012;16:39–45.
doi: 10.7812/TPP/11-127
pubmed: 22529758
pmcid: 3327110
ACS NSQIP Participant Use Data File [Internet]. American College of Surgeons. [cited 2022 Jan 31]. http://www.facs.org/quality-programs/acs-nsqip/participant-use
Webb ML, Lukasiewicz AM, Samuel AM, Bohl DD, Basques BA, Varthi AG, et al. Overall similar infection rates reported in the physician-reported Scoliosis Research Society Database and the Chart-abstracted American College of Surgeons National Surgical Quality Improvement Program Database. Spine (Phila Pa 1976). 2015;40:1431–5.
doi: 10.1097/BRS.0000000000001033
pubmed: 26110664
Shiloach M, Frencher SK, Steeger JE, Rowell KS, Bartzokis K, Tomeh MG, et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210:6–16.
doi: 10.1016/j.jamcollsurg.2009.09.031
pubmed: 20123325
Kou J, Fischgrund J, Biddinger A, Herkowitz H. Risk factors for spinal epidural hematoma after spinal surgery. Spine (Phila Pa 1976). 2002;27:1670–3.
doi: 10.1097/00007632-200208010-00016
pubmed: 12163731
Sokolowski MJ, Garvey TA, Perl J, Sokolowski MS, Cho W, Mehbod AA, et al. Prospective study of postoperative lumbar epidural hematoma: incidence and risk factors. Spine (Phila Pa 1976). 2008;33:108–13.
doi: 10.1097/BRS.0b013e31815e39af
pubmed: 18165756
Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40–A:607–24.
doi: 10.2106/00004623-195840030-00009
pubmed: 13539086
Schupper AJ, Shuman WH, Baron RB, Neifert SN, Chapman EK, Gilligan J, et al. Utilization of the American Society of Anesthesiologists (ASA) classification system in evaluating outcomes and costs following deformity spine procedures. Spine Deform. 2021;9:185–90.
doi: 10.1007/s43390-020-00176-4
pubmed: 32780301
Deyo RA, Hickam D, Duckart JP, Piedra M. Complications following surgery for lumbar stenosis in a veteran Population. Spine (Phila Pa 1976). 2013;38:1695–702.
doi: 10.1097/BRS.0b013e31829f65c1
pubmed: 23778366
Lim S, Carabini LM, Kim RB, Khanna R, Dahdaleh NS, Smith ZA. Evaluation of American Society of Anesthesiologists classification as 30-day morbidity predictor after single-level elective anterior cervical discectomy and fusion. Spine J. 2017;17:313–20.
doi: 10.1016/j.spinee.2016.09.018
pubmed: 27669670
Phan K, Kim JS, Lee NJ, Kothari P, Cho SK. Relationship between ASA scores and 30-Day readmissions in patients undergoing Anterior Cervical Discectomy and Fusion. Spine (Phila Pa 1976). 2017;42:85–91.
doi: 10.1097/BRS.0000000000001680
pubmed: 27172282
Kay HF, Sathiyakumar V, Yoneda ZT, Lee YM, Jahangir AA, Ehrenfeld JM, et al. The effects of American Society of anesthesiologists physical status on length of stay and inpatient cost in the surgical treatment of isolated orthopaedic fractures. J Orthop Trauma. 2014;28:e153–159.
doi: 10.1097/01.bot.0000437568.84322.cd
pubmed: 24149446
Uribe J, Moza K, Jimenez O, Green B, Levi ADO. Delayed postoperative spinal epidural hematomas. Spine J. 2003;3:125–9.
doi: 10.1016/S1529-9430(02)00535-1
pubmed: 14589226
Aono H, Ohwada T, Hosono N, Tobimatsu H, Ariga K, Fuji T, et al. Incidence of postoperative symptomatic epidural hematoma in spinal decompression surgery. J Neurosurg Spine. 2011;15:202–5.
doi: 10.3171/2011.3.SPINE10716
pubmed: 21529204