Coagulation Profile as a Risk Factor for 30-Day Morbidity and Mortality Following Posterior Lumbar Fusion

Study Design. A retrospective cohort study. Objective. The aim of this study was to identify associations between abnormal coagulation profile and postoperative morbidity and mortality in patients undergoing posterior lumbar fusion (PLF). Summary of Background Data. The literature suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little research that directly addresses the influence of coagulation profile on postoperative complications following PLF. Methods. The American College of Surgeons National Surgical Quality Improvement Program database (ACS-NSQIP) was utilized to identify patients undergoing PLF between 2006 and 2013. Nine thousand two hundred ninety-five patients met inclusion criteria. Multivariate analysis was utilized to identify associations between abnormal coagulation profile and postoperative complications. Results. Low platelet count was an independent risk factor for organ space surgical site infections (SSIs) [odds ratio (OR)=6.0, P<0.001], ventilation >48hours (OR=4.5, P=0.002), Acute renal failure (OR=5.8, P=0.007), transfusion (OR=1.6, P<0.001), sepsis (OR=2.2, P=0.037), reoperation (OR=2.5, P=0.001), and death (OR=3.7, P=0.049). High partial thromboplastin time (PTT) was an independent risk factor for ventilation >48hours (OR=5.6, P=0.002), cerebrovascular accident (CVA)/stroke with neurological deficit (OR=5.1, P=0.011), cardiac arrest (OR=5.4, P=0.030), transfusion (OR=1.5, P=0.020), and death (OR=4.5, P=0.050). High International Normalized Ration (INR) was an independent risk factor for pneumonia (OR=8.7, P=0.001), pulmonary embolism (OR=5.6, P=0.021), deep venous thrombosis/Thrombophlebitis (OR=4.8, P=0.011), septic shock (OR=8.4, P=0.048), and death (OR=9.8, P=0.034). Bleeding disorder was an independent risk factor for organ space SSI (OR=5.4, P=0.01), pneumonia (OR=3.0, P=0.023), and sepsis (OR=4.4, P<0.001). Conclusion. Abnormal coagulation profile was an independent predictor of morbidity and mortality in patients undergoing PLF. As such, it should be considered in preoperative optimization and risk stratification.