Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Venous thromboembolism (VTE) represents a significant complication after spine surgery, with reported rates as high as 2%–4%. Published institutional practices for VTE prophylaxis are highly variable. In 2008, the authors implemented a departmental protocol for early VTE prophylaxis consisting of combined compressive devices and subcutaneous heparin initiated either preoperatively or on the same day of surgery. In this study, the authors compared the incidence of VTE in spine surgery patients before and after implementing this protocol.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>An institutional review board–approved retrospective review of outcomes in patients undergoing spine surgery 2 years before protocol implementation (representing the preprotocol group) and of outcomes in patients treated 2 years thereafter (the postprotocol group) was conducted. Inclusion criteria were that patients were 18 years or older and had been admitted for 1 or more days. Before 2008 (preprotocol), VTE prophylaxis was variable and provider dependent without any uniform protocol. Since 2008 (postprotocol), a new VTE-prophylaxis protocol was administered, starting either preoperatively or on the same day of surgery and continuing throughout hospitalization. The new protocol consisted of 5000 U heparin administered subcutaneously 3 times daily, except in patients older than 75 years or weighing less than 50 kg, who received this dose twice daily. All patients also received sequential compression devices (SCDs). The incidence of VTE in the 2 protocol phases was identified by codes of the International Classification of Diseases, Ninth Revision (ICD-9) codes for deep vein thrombosis (DVT) and pulmonary embolus (PE). Bleeding complications arising from anticoagulation treatments were evaluated by the Current Procedural Terminology (CPT) code for postoperative epidural hematoma (EDH) requiring evacuation.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In total, 941 patients in the preprotocol group met the inclusion criteria: 25 had DVT (2.7%), 6 had PE (0.6%), and 6 had postoperative EDH (0.6%). In the postprotocol group, 992 patients met the criteria: 10 had DVT (1.0%), 5 had PE (0.5%), and 4 had postoperative EDH (0.4%). This reduction in DVT after the protocol's implementation was statistically significant (p = 0.009). Despite early aggressive prophylaxis, the incidence of postoperative EDH did not increase and compared favorably to the published literature.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>At a high-volume tertiary center, an aggressive protocol for early VTE prophylaxis after spine surgery decreases VTE incidence without increasing morbidity.</jats:p></jats:sec>

Prä- und postoperative Fast-track-Behandlungskonzepte in der Wirbelsäulenchirurgie

“…Unterschiedliche Ergebnisse bieten Metaanalysen und Untersuchungen zur Verwendung von Kompressionsstrümpfen und medikamentöser Thromboseprophylaxe, die einerseits eine frühzeitige Einleitung einer Prophylaxe mit niedermolekularem Heparin vorsehen und andererseits den Effekt einer Kompressionsstrumpfbehandlung unterstreichen [3,6]. Ein Review, welches die Auswirkungen einer frühzeitigen Mobilisation mit Physiotherapie auf das Outcome nach Wirbelsäulenoperationen darstellte, kam zu der Aussage, dass aktuell bei begrenzter Vergleichbarkeit ein Mangel an Forschung mit ungenauer Datenlage vorläge [20].…”

“…4 8 a-d Bewertungen der WirbelsäulenpatientenschuleAbb 3. 8 Bilder einer Patientenschule mit allgemeiner Information (a), physiotherapeutischen Übungen (b) und individueller Aufklärung (c)…”

Medication reconciliation for patients undergoing spinal surgery

“…Nevertheless, several authors have investigated other factors which may influence outcome in spinal surgery patients, such as psychological factors [3] or perioperative medication [4,5]. Among the quality issues currently under close observation by the public is medication safety.…”

The National Neurosurgery Quality and Outcomes Database Qualified Clinical Data Registry: 2015 measure specifications and rationale

“…60,155 In the postoperative phase, appropriate mechanical and chemical prophylaxis for venous thrombosis, timely removal of urinary catheters, meticulous blood glucose control, appropriate mobilization of patients, and close neurological monitoring can reduce the incidence of these events. 31,79,98 Implementation of most of these factors is nonuniform and often varies by physician within a given institution, leading to variability in complication rates and types. …”