ABSTRACT
BACKGROUND CONTEXT: The ever-evolving COVID-19 pandemic has presented critical surgical management challenges. Increases in COVID-19 positive patients and subsequently, patients sustaining spinal fractures who test positive for COVID-19, raises the question of whether these individuals are at an increased risk of mortality and subsequent complications. PURPOSE: The purpose of this study was to characterize the cohort of COVID-19-positive patients who required surgery following a spinal fracture and investigate if these patients are at increased risk of all-cause mortality and further complications. STUDY DESIGN/SETTING: Retrospective cohort study of prospectively collected data performed from March 15, 2020 to December 12, 2021 using a national database with clinical data from 56 sites. PATIENT SAMPLE: Patients with a diagnostic test for COVID-19, who sustained spinal fractures and required operative intervention. OUTCOME MEASURES: The primary outcome was all-cause mortality. Additional outcomes included acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), venous thromboembolism (VTE) and sepsis. METHOD(S): A total population of 8.4 million patients was examined using the National COVID Cohort Collaborative (N3C) data enclave. The N3C is a centralized national data resource that compiles data using electronic health care records from over 8 million patients. Inclusion criteria consisted of adults 18 years old or older with a diagnostic test for COVID-19, who sustained spinal fractures and required operative intervention. Patients' information from this database was collected and grouped according to lab-confirmed COVID-19-positive and negative testing which was acquired via the "SARS-CoV-2 RT-PCR and Antigen" test. Those who tested positive for COVID-19 were compared to a control group that was COVID-19-negative using the same standardized PCR and antigen testing methods. RESULT(S): A total of 2,745 patients with operative spinal fractures were identified. A group of 207 (8%) patients tested COVID-19 positive at the time of surgery. At baseline, the groups were comparable in age (57 vs 58 years), gender (41% women in each group), body mass index (28 in each group), cervical spinal cord injury (9.8% vs 8.1%) and length of stay (8 days in each group) (all p>0.05). The COVID-19positive cohort had a higher all-cause mortality than the COVID-19 negative group (14% vs 7%, p<0.001). There were increased odds for AKI [1.62(1.15, 2.26)], ARDS [2.78(2.07, 3.73)], VTE [1.65(1.18, 2.30)], and sepsis [2.58(1.88,3.53)] [Odds Ratio (Lower Limit, Upper Limit)] in patients testing positive for COVID-19. CONCLUSION(S): This national analysis of operative spinal fractures and COVID-19 showed increased mortality and perioperative events (AKI, ARDS, VTE, Sepsis). Further research is needed to investigate potential interventions for testing and management related to COVID-19 in the context of operative spinal fractures. FDA DEVICE/DRUG STATUS: This does not discuss or include any applicable devices or drugs. Copyright © 2022
ABSTRACT
Background: Several studies have been published on a rare side effect of severe venous thrombosis at unusual sites and thrombocytopenia after vaccination against SARS-CoV- 2, referred to as vaccine-induced immune thrombocytopenia and thrombosis (VITT). Aim(s): To identify new cases of acute splanchnic vein thrombosis (SVT) or Budd-Chiari Syndrome (BCS) who presented following SARS-CoV- 2 vaccination in the Vascular Liver Disease Group (VALDIG) network, and to evaluate the incidence of VITT. Method(s): We conducted a prospective international cohort study between May 1st, 2021 and January 10th, 2022, on consecutive patients with acute SVT or BCS who presented within 6 weeks following any type or dose of SARS-CoV- 2 vaccination. Anonymous data were collected including baseline characteristics, risk factors, treatment and survival. Cases were identified as definite VITT, probable VITT or possible VITT or unlikely VITT as defined by Pavord et al (NEJM 2021). Result(s): 25 patients with acute (N = 24) or recurrent (N = 1) SVT or BCS were collected from 14 centers in 4 countries (after ChAdOx1 nCoV-19 N = 11, BNT162b2 N = 9, Ad26.COV2.S N = 1, mRNA-1273 N = 1). Median time after vaccination to symptoms was 10 days (2-40). Median age was 52.5 years (21-66), 52% were female. Three patients (12%) fulfilled criteria for definite VITT, 6 (24%) for probable VITT, 2 (8%) for possible VITT, 14 (56%) for unlikely VITT. Thrombosis was located in the portal vein (N = 20), hepatic vein(s) (N = 9), mesenteric vein (N = 18) or splenic vein (N = 9). Concomitant extra-abdominal thrombosis was seen in 5 patients (20%). Patients were treated with LMWH (60%), DOACs (24%) or VKA (40%). Six (2/3 with definite VITT) received IVIG. Thrombophilia was found in 5 patients and 3 had a myeloproliferative neoplasm. Conclusion(s): 25 cases of acute SVT or BCS following SARS-CoV- 2 vaccination were identified. Although definite VITT was rare (12%), no underlying disorder was identified in the majority of patients, contrary to 'typical' cases of SVT and BCS.