Risk factors for venous thromboembolism after lumbar fusion: a meta-analysis

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious complication that can occur following lumbar fusion surgery. Identifying the risk factors associated with VTE after lumbar fusion is crucial for developing effective prevention strategies. We conducted a meta-analysis of cohort and case-control studies to evaluate the risk factors for VTE following lumbar fusion surgery. A comprehensive search was performed in PubMed, Embase, and the Cochrane Library up to June 2024. Data extraction and quality assessment were carried out independently by two researchers. Statistical analyses were conducted using STATA 15.1. A total of 24 studies were included in the meta-analysis. Significant risk factors for VTE after lumbar fusion included advanced age (OR = 1.06, 95% CI: 1.01–1.13), prolonged operative duration (OR = 3.34, 95% CI: 2.25–4.95), anterior fusion compared to posterior fusion (OR = 1.43, 95% CI: 1.27–1.61), corticosteroid use (OR = 1.32, 95% CI: 1.05–1.66), elevated D-dimer levels (OR = 2.39, 95% CI: 1.39–4.12) and hypertension (OR = 1.47, 95% CI: 1.14–1.90). Coagulation dysfunction, fibrinogen level, HDL level, cardiac disease, and diabetes were not significantly correlated with VTE risk. In conclusion, this study identifies key risk factors including advanced age, prolonged operative duration, anterior fusion, corticosteroid use, elevated D-dimer levels and hypertension, for VTE following lumbar fusion surgery. These findings can inform clinical guidelines and improve patient management by targeting modifiable risk factors and optimizing perioperative care.