Effects of discontinuance of preoperative anti-platelet medication in multi-level thoracolumbar spine surgery

Lee, Jung Hoon; Son, Dong Wuk; Sung, Soon Ki; Lee, Sang Weon; Song, Geun Sung

doi:10.5137/1019-5149.jtn.18306-16.1

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…The total number of operations in PSL has been rising annually, especially in China [ 17 , 18 ]. Significant blood loss is the most frequent surgical complication and receiving a great deal of attention in the spinal surgeon, as well as anesthesiologist [ 19 ]. There was no consensus among the definition of major blood loss; it is generally accepted that one volume of blood loss reaching the total blood loss (60 ml/kg adult) within 24 h was defined as major blood loss [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

Wang

et al. 2021

J Orthop Surg Res

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Background The aim of this study was to determine the risk factors and develop a nomogram for blood transfusions after posterior lumbar spinal fusion (PSL). Methods We conducted a retrospective, single-center study based on 885 patients receiving PSL, and data was obtained from May 2015 to September 2019. Univariable and multivariable logistics regression analysis were conducted to identify risk factors for blood transfusion, and a nomogram was constructed to individually evaluate the risk of blood transfusion. Discrimination, calibration, and clinical usefulness were validated by the receiver operating characteristics (ROC), C-index, calibration plot, and decision curve analysis, respectively. Bootstrapping validation was performed to assess the performance of the model. Results Of 885 patients, 885 were enrolled in the final study population, and 289 received blood transfusion. Statistical analyses showed that low preoperative hemoglobin (Hb), longer time to surgery, operative time, levels of fusion > 1, longer surgery duration, and higher total intraoperative blood loss (IBL) were the risk factors for transfusion. The C-index was 0.898 (95% CI 0.847–0.949) in this dataset and 0.895 in bootstrapping validation, respectively. Calibration curve showed satisfied discrimination and calibration of the nomogram. Decision curve analysis (DCA) shown that the nomogram was clinical utility. Conclusions In summary, we investigated the relationship between the blood transfusion requirement and predictors: levels of fusion, operative time, time to surgery, total intraoperative EBL, and preoperative Hb level. Our nomogram with a robust performance in the assessment of risk of transfusion can contribute to clinicians in making clinical decision. However, external validation is still needed in the further.

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Section: Discussionmentioning

confidence: 99%

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

Wang

et al. 2021

J Orthop Surg Res

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“…Some authors have described a significant relation between an increased risk of pSEH and the use of NSAR, 11,28 whereas others have not. 23,[33][34][35] Outcome Our analysis identified some paradigms influencing the level of neurologic outcome after the treatment of pSEH. The prognosis after pSEH strongly depends on the intensity of the symptoms, the interval to revision surgery, the levels of spinal involvement, and the degree of neurologic deficits.…”

Section: Risk Factorsmentioning

confidence: 99%

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Hohenberger

Zeman²,

Höhne

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Objective Postoperative spinal epidural hematoma (pSEH) with symptomatic compression of nervous structures after spinal decompression surgery is a rare complication. Delayed evacuation may result in severe neurologic impairment. We present a large single-center analysis of the prevalence, potential risk factors, and functional recovery after pSEH. Methods A retrospective review of our institutional database of spinal decompression surgery over 15 years yielded 6,024 consecutive patients. A total of 42 patients who had undergone surgical revision due to postoperative neurologic deterioration or intractable radiating pain and radiographically confirmed pSEH were allocated to the pSEH group. A matched 3:1 control group was formed (126 patients with the same surgical procedure, same year, same sex, and similar age). Charts, surgical reports, and radiographic data were reviewed for demographics, duration of symptoms, history of medical treatment, medication, comorbidities, radiographic extension, surgical strategy, and pre- and postoperative neurologic performance. Median follow-up was 3 months. Risk factors for pSEH, complete recovery, and recovery of neurologic symptoms were analyzed with univariable and multivariable logistic regression models. Results The prevalence of pSEH in this population was 0.69% (n = 42) with these locations: 7 of 1,284 (0.54%) cervical, 1 of 774 (0.12%) thoracic, and 34 of 3,966 (0.85%) lumbar. Use of anticoagulants (p = 0.003), pathologic coagulation values in the preoperative blood test (p = 0.034), and cigarette smoking (p = 0.003) were identified as independent risk factors of pSEH. Surgery in more than one level showed a trend toward an increased risk of pSEH. Pain as the only symptom (p = 0.0001) was a significant predictor of complete recovery. Patients symptomatic with paraplegia (p = 0.026) had a significantly higher risk of a poor neurologic outcome without full recovery of neurologic symptoms. Conclusion The prevalence of pSEH was lower than previously reported incidences. Use of anticoagulants, pathologic coagulation values, and cigarette smoking were identified as independent risk factors of pSEH. Functional outcome was related to the duration between hematoma evacuation and the clinical presentation of symptomatic pSEH.

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“…Despite the large amount of data published on specific thromboprophylactic therapies for various spine surgery indications, well-established guidelines and algorithms have had difficulty gaining widespread acceptance and adherence. 2 , 15 - 18 , 20 - 23 , 38 - 43 Although spine surgery VTE prophylaxis recommendations from North American Spine Society and American College of Chest Physicians have been published, these groups describe “spine surgery” as a broad category, not taking into account the differing VTE and bleeding complication risks associated with specific surgical procedures and the location in the spine. 18 , 44 To this point, Eskildsen et al 45 worked to develop an algorithm for thromboprophylaxis in spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey

Louie

Harada

Mroz

et al. 2020

Global Spine Journal

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Study Design: Cross-sectional, international survey. Objectives: This study addressed the global perspectives concerning perioperative use of pharmacologic thromboprophylaxis during spine surgery along with its risks and benefits. Methods: A questionnaire was designed and implemented by expert members in the AO Spine community. The survey was distributed to AO Spine’s spine surgeon members (N = 3805). Data included surgeon demographic information, type and region of practice, anticoagulation principles, different patient scenarios, and comorbidities. Results: A total of 316 (8.3% response rate) spine surgeons completed the survey, representing 64 different countries. Completed surveys were primarily from Europe (31.7%), South/Latin America (19.9%), and Asia (18.4%). Surgeons tended to be 35 to 44 years old (42.1%), fellowship-trained (74.7%), and orthopedic surgeons (65.5%) from academic institutions (39.6%). Most surgeons (70.3%) used routine anticoagulation risk stratification, irrespective of geographic location. However, significant differences were seen between continents with anticoagulation initiation and cessation methodology. Specifically, the length of a procedure ( P = .036) and patient body mass index ( P = .008) were perceived differently when deciding to begin anticoagulation, while the importance of medical clearance ( P < .001) and reference to literature ( P = .035) differed during cessation. For specific techniques, most providers noted use of mobilization, low-molecular-weight heparin, and mechanical prophylaxis beginning on postoperative 0 to 1 days. Conversely, bridging regimens were bimodal in distribution, with providers electing anticoagulant initiation on postoperative 0 to 1 days or days 5-6. Conclusion: This survey highlights the heterogeneity of spine care and accentuates geographical variations. Furthermore, it identifies the difficulty in providing consistent perioperative anticoagulation recommendations to patients, as there remains no widely accepted, definitive literature of evidence or guidelines.

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Effects of discontinuance of preoperative anti-platelet medication in multi-level thoracolumbar spine surgery

Cited by 7 publications

References 3 publications

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

Symptomatic Postoperative Spinal Epidural Hematoma after Spinal Decompression Surgery: Prevalence, Risk Factors, and Functional Outcome

Perioperative Anticoagulation Management in Spine Surgery: Initial Findings From the AO Spine Anticoagulation Global Survey

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