Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions

Brandon Shallop, Alexandria Starks, Simon Greenbaum, David S. Geller, Alan Lee, John Ready, Geno Merli, Mitchell Maltenfort, John A. Abraham

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

BACKGROUND: The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population.

METHODS: A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests.

RESULTS: The overall rate of VTE was twenty-four (7.1%) of the 336; thirteen (3.9%) were pulmonary embolism (PE), and eleven (3.3%), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p <0.001) or PE (p <0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3%) of the operations.

CONCLUSIONS: There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population.

Original languageEnglish (US)
Pages (from-to)1503-1511
Number of pages9
JournalThe Journal of bone and joint surgery. American volume
Volume97
Issue number18
DOIs
StatePublished - Sep 16 2015

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Intramedullary Fracture Fixation
Thromboembolism
Venous Thromboembolism
Bone and Bones
Anticoagulants
Pulmonary Embolism
Wounds and Injuries
Population
National Cancer Institute (U.S.)
Bone Fractures
Venous Thrombosis
Lung Neoplasms
Histology
Radiotherapy
Logistic Models
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions. / Shallop, Brandon; Starks, Alexandria; Greenbaum, Simon; Geller, David S.; Lee, Alan; Ready, John; Merli, Geno; Maltenfort, Mitchell; Abraham, John A.

In: The Journal of bone and joint surgery. American volume, Vol. 97, No. 18, 16.09.2015, p. 1503-1511.

Research output: Contribution to journalArticle

Shallop, B, Starks, A, Greenbaum, S, Geller, DS, Lee, A, Ready, J, Merli, G, Maltenfort, M & Abraham, JA 2015, 'Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions', The Journal of bone and joint surgery. American volume, vol. 97, no. 18, pp. 1503-1511. https://doi.org/10.2106/JBJS.N.01067
Shallop, Brandon ; Starks, Alexandria ; Greenbaum, Simon ; Geller, David S. ; Lee, Alan ; Ready, John ; Merli, Geno ; Maltenfort, Mitchell ; Abraham, John A. / Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions. In: The Journal of bone and joint surgery. American volume. 2015 ; Vol. 97, No. 18. pp. 1503-1511.
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abstract = "BACKGROUND: The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population.METHODS: A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests.RESULTS: The overall rate of VTE was twenty-four (7.1{\%}) of the 336; thirteen (3.9{\%}) were pulmonary embolism (PE), and eleven (3.3{\%}), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p <0.001) or PE (p <0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3{\%}) of the operations.CONCLUSIONS: There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population.",
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AU - Shallop, Brandon

AU - Starks, Alexandria

AU - Greenbaum, Simon

AU - Geller, David S.

AU - Lee, Alan

AU - Ready, John

AU - Merli, Geno

AU - Maltenfort, Mitchell

AU - Abraham, John A.

PY - 2015/9/16

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N2 - BACKGROUND: The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population.METHODS: A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests.RESULTS: The overall rate of VTE was twenty-four (7.1%) of the 336; thirteen (3.9%) were pulmonary embolism (PE), and eleven (3.3%), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p <0.001) or PE (p <0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3%) of the operations.CONCLUSIONS: There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population.

AB - BACKGROUND: The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population.METHODS: A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests.RESULTS: The overall rate of VTE was twenty-four (7.1%) of the 336; thirteen (3.9%) were pulmonary embolism (PE), and eleven (3.3%), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p <0.001) or PE (p <0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3%) of the operations.CONCLUSIONS: There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population.

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