Low-Molecular-Weight Heparin Prophylaxis 24 to 36 Hours After Degenerative Spine Surgery

Strom, Russell G.; Frempong-Boadu, Anthony

doi:10.1097/brs.0b013e3182a4408d

Cited by 69 publications

(73 citation statements)

References 27 publications

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“…19 Beyond this, for surgeons who choose to order DVT prophylaxis medications, the timing of the first dose varies considerably, from immediately postoperatively to 96 hours later. 20 Heterogeneity is further demonstrated in the length of prescription of these medications, particularly in the setting of malignancy. 19,21 This inconsistency in DVT prophylaxis very likely reflects the lack of high level of evidence studies to guide these decisions; however, the literature is very clear that pharmacological approaches to preventing DVT are safe, effective, and necessary.…”

Section: Discussionmentioning

confidence: 99%

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Carl

Coon

Calotta

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:Posterior trunk reconstruction is increasingly possible as a result of advances in spinal instrumentation, reconstructive approaches, and perioperative critical care. Extensive cases often require a muscle flap or complex closure to obliterate dead space. Postsurgical wound complications and subsequent reoperations can lead to neural injury, higher hospital costs, and longer hospitalizations. We aim to identify risk factors that are associated with increased length of stay (LOS) for patients receiving flaps to close a spinal defect.Methods:A single institution, retrospective cohort study was performed on all patients from 2002 to 2014 who received a muscle flap to close a spine defect. Medical and perioperative variables that were significantly associated with LOS (P < 0.05) in univariate analysis were included in a stepwise regression model.Results:A total of 288 cases were identified. Presence of instrumentation, preoperative chemotherapy, wound dehiscence, cerebrospinal fluid leak, partial/total flap loss, and medical morbidity occurrence were all independently associated with increased LOS in a combined multivariate model (P < 0.02 for each of the 6 variables). Importantly, Kaplan–Meier analysis demonstrated that postoperative wound dehiscence increased LOS by 12 days.Conclusions:Spinal tumor resections often create large cavitary defects that necessitate the use of muscle flaps for closure. Patients who have received adjuvant chemotherapy require instrumentation, or those who develop specific wound-related or medical complications are at increased risk for prolonged hospitalization after spinal reconstruction. Thus, implementing measures to mitigate the occurrence of these adverse events will reduce costs and decrease the length of hospitalization.

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Section: Discussionmentioning

confidence: 99%

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Carl

Coon

Calotta

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…Three studies [3,19,23] reported relation between walking disability preoperation and incidence of VTE. In our analysis, the result showed that walking disability preoperation significantly increased the incidence for VTE ( P < 0.00001).…”

Section: Discussionmentioning

confidence: 99%

“…About half of all untreated DVT cases are complicated by PE, and, on the contrary, 50% to 80% of all untreated PE cases are related to DVT. [2,3] Attention must be paid on VTE for surgeons, and increasing studies reported on risk factors of VTE.…”

Section: Introductionmentioning

confidence: 99%

“…[4–6] Many studies reported on VTE after hip or knee arthroplasty. [7–15] However, several studies focused on the risk factors of VTE in patients undergoing spine surgery [3,8,15–20] and the incidence varied among these studies. Risk factors including long-time bed rest postoperatively and lack of lower limb activity are related to VTE after spine surgery.…”

Section: Introductionmentioning

confidence: 99%

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Factors predicting venous thromboembolism after spine surgery

et al. 2016

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Background:A meta-analysis was performed to explore predicted factors of venous thromboembolism (VTE) after surgery in the treatment for spine degeneration diseases.Summary of background data:Many scholars have focused on VTE after spine surgery, but as for the risk factors of VTE have not reached a consensus.Methods:An extensive search of literature, “spine or spinal,” “degeneration,” “after surgery or postoperation,” and “venous thromboembolism” as key words, was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases. The following variables were extracted: wearing elastic stocking, hypertension (HT), heart disease, diabetes, drinking, anticoagulant therapy, walking disability preoperation, smoking, sex, age, surgical duration, fusion versus nonfusion (lumbar fusion vs lumbar discectomy), surgical site (cervical vs lumbar), blood loss, and body mass index. Data analysis was conducted with RevMan 5.3 and STATA 12.0.Results:A total of 12 studies were identified, including 34,597 patients of whom 624 patients had VTE, and the incidence of VTE was 2% in all patients who underwent spine surgery. The incidence of VTE for Asian patients was 7.5%, compared with 1% VTE for Occidental patients; the difference was significant (P < 0.0001). The pooled analysis showed that there were significant differences regarding wearing elastic stocking (odds ratio [OR] = 11.71, 95% confidence interval [CI] [1.46, 94.00], P = 0.02), walking disability preoperation (OR = 4.80, 95% CI [2.53, 9.12], P < 0.00001), surgical site (lumbar surgery) (OR = 0.23, 95% CI [0.20, 0.27], P < 0.00001), HT (OR = 1.59, 95% CI [1.21, 2.10], P = 0.001), and diabetes (OR = 2.12, 95% CI [1.09, 4.10], P = 0.03). However, there were no significant differences in blood loss, heart disease, smoking, sex, surgical duration, body mass index, surgical duration, anticoagulant therapy, wearing elastic stocking, fusion versus nonfusion, drinking, and age (all P > 0.05).Conclusions:Based on our meta-analysis, Asian patients, patients with walking disability preoperation, patients wearing elastic stocking, patients having undergone lumbar surgery, patients with a history of HT, and patients experiencing diabetes have a higher incidence of VTE after spine surgery.

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“…Pharmacological prophylaxis is recommended when surgically treating spinal cord injury; however, conclusive results are not available regarding degenerative spine surgery. 34 These findings highlight the need for more effort to avoid these preventable events in ways that minimize the risk of bleeding within the central nervous system. Anemia was more common among readmitted patients.…”

mentioning

confidence: 99%

Causes of 30-day readmission after neurosurgery of the spine

Cusimano

Pshonyak

Lee

et al. 2016

SPI

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OBJECT Thirty-day readmission has been cited as an important indicator of the quality of care in several fields of medicine. The aim of this systematic review was to examine rate of readmission and factors relevant to readmission after neurosurgery of the spine. METHODS The authors carried out a systematic review using several databases, searches of cited reference lists, and a manual search of the JNS Publishing Group journals (Journal of Neurosurgery; Journal of Neurosurgery: Spine; Journal of Neurosurgery: Pediatrics; and Neurosurgical Focus), Neurosurgery, Acta Neurochirurgica, and Canadian Journal of Neurological Sciences. A quality review was performed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS A systematic review of 1136 records published between 1947 and 2014 revealed 31 potentially eligible studies, and 5 studies met inclusion criteria for content and quality. Readmission rates varied from 2.54% to 14.7%. Sequelae that could be traced back to complications that arose during neurosurgery of the spine were a prime reason for readmission after discharge. Increasing age, poor physical status, and comorbid illnesses were also important risk factors for 30-day readmission. CONCLUSIONS Readmission rates have predictable factors that can be addressed. Strategies to reduce readmission that relate to patient-centered factors, complication avoidance during neurosurgery, standardization with system-wide protocols, and moving toward a culture of nonpunitive system-wide error and “near miss” investigations and quality improvement are discussed.

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Low-Molecular-Weight Heparin Prophylaxis 24 to 36 Hours After Degenerative Spine Surgery

Cited by 69 publications

References 27 publications

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Surgical Factors Associated with Prolonged Hospitalization after Reconstruction for Oncological Spine Surgery

Factors predicting venous thromboembolism after spine surgery

Causes of 30-day readmission after neurosurgery of the spine

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