Thoracolumbar spine surgery in the post-pandemic era: a national retrospective analysis of thrombotic complications, vaccination status, and prior hospitalization with COVID-19.

Abstract

Retrospective cohort study. To compare thrombotic complication rates in thoracolumbar spine surgery patients before and after the coronavirus disease 2019 (COVID-19) pandemic. Thrombotic complications are a major cause of postoperative morbidity and mortality in spine surgery. Both COVID-19 infection and vaccination have been linked to hypercoagulability. However, data on pre- versus post-pandemic thrombotic risk in spine surgery are limited, and the influence of infection severity or vaccination status has not been examined. Adult patients (≥18 years) undergoing primary thoracolumbar decompression with or without fusion were identified, excluding trauma and neoplastic cases. Patients were divided into "pre-COVID" and "post-COVID" cohorts. Outcomes included 90-day rates of postoperative deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and cerebrovascular accident (CVA). Cohorts were compared using Pearson's chi-square tests, and multivariable regression adjusted for demographics and comorbidities. A total of 784,498 patients were included. Post-COVID, rates of DVT (1.4% vs. 1.3%; risk ratio [RR], 1.11; p <0.001), PE (0.9% vs. 0.8%; RR, 1.14; p <0.001, and CVA (0.8% vs. 0.7%; RR, 1.17; p <0.001) were higher. Multivariable analysis demonstrated a 7% increase in odds of VTE post-COVID (odds ratios [OR], 1.07; p =0.002). Unvaccinated patients had a 6% higher odds of VTE (OR, 1.06; p =0.006), whereas vaccinated patients showed a nonsignificant increase (OR, 1.16; p =0.109). Patients with prior COVID-19 hospitalization had approximately double the odds of VTE (OR, 2.03; p =0.011). Thrombotic complications modestly increased after the COVID-19 pandemic. Vaccination status showed no clear association, while prior hospitalization for COVID-19 was the strongest predictor of postoperative thrombotic risk.