Outcomes Following Posterior Lumbar Fusion in Polycythemia Vera Patients.

October 25, 2019

BACKGROUND:

Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm that is associated with an increased risk for venous and arterial thromboembolism. The aim of this study is to evaluate outcomes following elective posterior lumbar and posterior interbody fusion (PLF/PLIF) among PV patients.

METHODS:

Utilizing PearlDiver, a retrospective national database, Medicare patients less than 85 years who underwent an elective primary posterior lumbar fusion (ICD-9-CM: 81.07) and/or posterior lumbar interbody fusion (ICD-9-CM: 81.08) for degenerative lumbar spine pathologies from 2006-2013 were identified. Following our inclusion and exclusion criteria, we separated our resulting PLF/PLIF cohort into patients with a prior diagnosis of PV (ICD-9-CM: 238.4) and a control cohort of patients without a history of PV. Comparisons of postoperative outcomes were made between identified PV patients and our matched control group. Significance was set at 0.05.

RESULTS:

In total, 1,491 PV patients and a matched control cohort of 29,056 patients were selected. PV patients had a significantly increased rate of 90-day acute pulmonary embolism (1.9% versus 1.2%; OR 1.65, 95% CI 1.10-2.38, p=0.010), 90-day lower extremity DVT (3.4% versus 1.9%; OR 1.81, 95% CI 1.33-2.40, p<0.001), and one-year diagnosis of surgical site infections (5.4% versus 4.2%; OR 1.30, 95% CI 1.02-1.63, p=0.027) compared to patients without a history of PV. Nonetheless, PV was not associated with other major medical complications including stroke, myocardial infarction, and mortality following PLF/PLIF.

CONCLUSION:

PV patients undergoing elective PLF/PLIF have a significantly increased risk for pulmonary embolism, lower extremity deep vein thrombosis and surgical site infections.