Does Spine Surgery in Patients with a History of Bariatric Gastrectomy Increase the Risk of Delayed Pulmonary Embolism?
Abstract
Background: This is a novel observation report on patients undergoing spine surgery with a history of bariatric procedures.
Acknowledgment of aggregated complications in such patients can prevent catastrophic outcomes.
Case Report: We report three patients with spinal disorders and a history of bariatric surgery who developed pulmonary embolism following spine surgery. None of the patients had a history of venous thromboembolism or deep vein thrombosis (DVT) before this event. All patients were given thromboprophylaxis after both bariatric and spine surgery, including intra- and post-operative mechanical and pharmacological thromboprophylaxis upon discharge.
Conclusion: Patients undergoing spine surgery with a history of bariatric procedures are at increased risk of developing venous thromboembolic complications, including pulmonary embolism. We recommend extensive venous thromboembolic evaluation and treating these patients as high-risk individuals even in the absence of active thromboembolic disease.
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6. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical
patients: Antithrombotic therapy and prevention of
thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012; 141(2 Suppl):e227S-e277S. doi: 10.1378/chest.11-2297. [PubMed: 22315263]. [PubMed Central: PMC3278061].
7. Seidell JC, Flegal KM. Assessing obesity: Classification and epidemiology. Br Med Bull. 1997;53(2):238-52. doi: 10.1093/oxfordjournals.bmb.a011611. [PubMed: 9246834].
8. Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978-80. doi: 10.1016/j.amjmed.2005.03.012. [PubMed: 16164883].
9. Jakoi AM, Pannu G, D'Oro A, Buser Z, Pham MH, Patel NN, et al. The clinical correlations between diabetes, cigarette smoking and obesity on intervertebral degenerative disc disease of the lumbar spine. Asian Spine J. 2017;11(3):337-47. doi: 10.4184/asj.2017.11.3.337. [PubMed: 28670401]. [PubMed Central: PMC5481588].
10. Mihalko WM, Bergin PF, Kelly FB, Canale ST. Obesity, orthopaedics, and outcomes. J Am Acad Orthop Surg. 2014;22(11):683-90. doi: 10.5435/JAAOS-22-11-683. [PubMed: 25344593].
11. Hardesty CK, Poe-Kochert C, Son-Hing JP, Thompson GH. Obesity negatively affects spinal surgery in idiopathic scoliosis. Clin Orthop Relat Res. 2013;471(4):1230-5. doi: 10.1007/s11999-012-2696-6. [PubMed: 23192788]. [PubMed Central: PMC3586037].
12. Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: Analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013;95(1):1-8. doi: 10.2106/JBJS.K.01558. [PubMed: 23192403]. [PubMed Central: PMC3528022].
13. Joaquim AF, Helvie P, Patel AA. Bariatric surgery and low back pain: A systematic literature review. Global Spine J. 2020;10(1):102-10. doi: 10.1177/2192568219826935. [PubMed: 32002354]. [PubMed Central: PMC6963354].
14. Melissas J, Volakakis E, Hadjipavlou A. Low-back pain in morbidly obese patients and the effect of weight loss following surgery. Obes Surg. 2003;13(3):389-93. doi: 10.1381/096089203765887714. [PubMed: 12841899].
15. Steele KE, Schweitzer MA, Prokopowicz G, Shore AD, Eaton LC, Lidor AO, et al. The long-term risk of venous thromboembolism following bariatric surgery. Obes Surg. 2011;21(9):1371-6. doi: 10.1007/s11695-011-0445-7. [PubMed: 21625911].
16. Jain D, Berven SH, Carter J, Zhang AL, Deviren V. Bariatric surgery before elective posterior lumbar fusion is associated with reduced medical complications and infection. Spine J. 2018;18(9):1526-32. doi: 10.1016/j.spinee.2018.01.023. [PubMed: 29408400].
2. Pateder DB, Gonzales RA, Kebaish KM, Antezana DF, Cohen DB, Chang JY, et al. Pulmonary embolism after adult spinal deformity surgery. Spine (Phila Pa 1976). 2008;33(3):301-5. doi: 10.1097/BRS.0b013e31816245e1. [PubMed: 18303463].
3. Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O, et al. Overweight, obesity, and the risk of recurrent venous thromboembolism. Arch Intern Med. 2008;168(15):1678-83. doi: 10.1001/archinte.168.15.1678. [PubMed: 18695082].
4. Gonzalez QH, Tishler DS, Plata-Munoz JJ, Bondora A, Vickers SM, Leath T, et al. Incidence of clinically evident deep venous thrombosis after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2004;18(7):1082-4. doi: 10.1007/s00464-003-8202-1. [PubMed: 15156394].
5. Wu EC, Barba CA. Current practices in the prophylaxis of venous thromboembolism in bariatric surgery. Obes Surg. 2000;10(1): 7-13. doi: 10.1381/09608920060674021. [PubMed: 10715636].
6. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical
patients: Antithrombotic therapy and prevention of
thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012; 141(2 Suppl):e227S-e277S. doi: 10.1378/chest.11-2297. [PubMed: 22315263]. [PubMed Central: PMC3278061].
7. Seidell JC, Flegal KM. Assessing obesity: Classification and epidemiology. Br Med Bull. 1997;53(2):238-52. doi: 10.1093/oxfordjournals.bmb.a011611. [PubMed: 9246834].
8. Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978-80. doi: 10.1016/j.amjmed.2005.03.012. [PubMed: 16164883].
9. Jakoi AM, Pannu G, D'Oro A, Buser Z, Pham MH, Patel NN, et al. The clinical correlations between diabetes, cigarette smoking and obesity on intervertebral degenerative disc disease of the lumbar spine. Asian Spine J. 2017;11(3):337-47. doi: 10.4184/asj.2017.11.3.337. [PubMed: 28670401]. [PubMed Central: PMC5481588].
10. Mihalko WM, Bergin PF, Kelly FB, Canale ST. Obesity, orthopaedics, and outcomes. J Am Acad Orthop Surg. 2014;22(11):683-90. doi: 10.5435/JAAOS-22-11-683. [PubMed: 25344593].
11. Hardesty CK, Poe-Kochert C, Son-Hing JP, Thompson GH. Obesity negatively affects spinal surgery in idiopathic scoliosis. Clin Orthop Relat Res. 2013;471(4):1230-5. doi: 10.1007/s11999-012-2696-6. [PubMed: 23192788]. [PubMed Central: PMC3586037].
12. Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: Analysis of the Spine Patient Outcomes Research Trial (SPORT). J Bone Joint Surg Am. 2013;95(1):1-8. doi: 10.2106/JBJS.K.01558. [PubMed: 23192403]. [PubMed Central: PMC3528022].
13. Joaquim AF, Helvie P, Patel AA. Bariatric surgery and low back pain: A systematic literature review. Global Spine J. 2020;10(1):102-10. doi: 10.1177/2192568219826935. [PubMed: 32002354]. [PubMed Central: PMC6963354].
14. Melissas J, Volakakis E, Hadjipavlou A. Low-back pain in morbidly obese patients and the effect of weight loss following surgery. Obes Surg. 2003;13(3):389-93. doi: 10.1381/096089203765887714. [PubMed: 12841899].
15. Steele KE, Schweitzer MA, Prokopowicz G, Shore AD, Eaton LC, Lidor AO, et al. The long-term risk of venous thromboembolism following bariatric surgery. Obes Surg. 2011;21(9):1371-6. doi: 10.1007/s11695-011-0445-7. [PubMed: 21625911].
16. Jain D, Berven SH, Carter J, Zhang AL, Deviren V. Bariatric surgery before elective posterior lumbar fusion is associated with reduced medical complications and infection. Spine J. 2018;18(9):1526-32. doi: 10.1016/j.spinee.2018.01.023. [PubMed: 29408400].
| Files | ||
| Issue | Vol 7, No 4 (2021) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v7i4.8864 | |
| Keywords | ||
| Bariatric Surgery; Gastrectomy; Pulmonary Embolism; Spine; Venous Thromboembolism | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zarei M, Rostami M, Khan F. Does Spine Surgery in Patients with a History of Bariatric Gastrectomy Increase the Risk of Delayed Pulmonary Embolism?. J Orthop Spine Trauma. 2022;7(4):154-6.
