Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery

McLynn, Ryan P.; Diaz-Collado, Pablo J.; Ottesen, Taylor D.; Ondeck, Nathaniel T.; Cui, Jonathan J.; Bovonratwet, Patawut; Shultz, Blake N.; Grauer, Jonathan N.

doi:10.1016/j.spinee.2017.10.013

Cited by 53 publications

(60 citation statements)

References 22 publications

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“…A recent study demonstrated similar efficacy and hemorrhagic complications compared to our study with selective use of chemoprophylaxis. The comparison by McLynn et al 20 of the American College of Surgeons National Surgical Quality Improvement Program's database to institutional events found similar risk of bleeding and wound complications in the institutional cohort with selective use of chemical VTE prophylaxis (56.3% use, mainly unfractionated heparin) as in our study (20.7% use of LMWH). Further, no difference in the rate of VTE between mechanical and chemical prophylaxis was found when controlling for patient and procedural variables.…”

Section: Discussionsupporting

confidence: 76%

“…are needed to facilitate this; however, no stratification system was offered. 20 Careful and individualized consideration with a system such as the VTE Prophylaxis Risk/Benefit Score must be given to prevent both thrombotic and hemorrhagic complications. Kepler and associates 18 reviewed several studies assessing the risk of thrombosis and hemorrhage after spinal surgery and argued that the risk of postoperative thrombosis outweighed the risk of iatrogenic hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…In a decompressed and unprotected spinal cord or spinal nerve root, these unintended consequences may lead to devasting neurologic decline. 1,2,[14][15][16][17] The incidence of post-chemoprophylaxis epidural hematoma ranges from 0.3% to 3.5% 1,[18][19][20] ; the majority of patients with this complication require surgical evacuation and up to 50% 21,22 may be left with persistent neurologic deficit.…”

Section: Introductionmentioning

confidence: 99%

“…18,23 VTE prophylaxis in adult spinal surgery remains controversial. 14,18,20,23 In this analysis, we aimed to determine whether the VTE Prophylaxis Risk/Benefit Score can safely and effectively guide thromboprophylaxis following adult degenerative spinal surgery.…”

Section: Introductionmentioning

confidence: 99%

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An Evidence-Based Algorithm for Determining Venous Thromboembolism Prophylaxis After Degenerative Spinal Surgery

et al. 2020

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Background: Although venous thromboembolism (VTE) is a potentially serious and life-threatening complication, there is no widely accepted protocol to guide VTE prophylaxis in adult degenerative spinal surgery, and pharmacologic overtreatment may result in hemorrhagic complications. Previously, we published the VTE Prophylaxis Risk/Benefit Score, an evidence-based algorithm that balances the risk and consequences of thrombotic versus hemorrhagic complications by taking consideration of patient-related risks, procedure-related risks, and the risk of neurological compromise to guide VTE prophylaxis. To objective of this study was to validate the VTE Prophylaxis Risk/Benefit Score. Methods: From January 1, 2016, to December 31, 2017, VTE Prophylaxis Risk/Benefit Scores and corresponding prophylaxes were prospectively assigned. When indicated, chemoprophylaxis was dosed 24 to 36 hours postoperatively to allow for adequate surgical hemostasis. Patients were retrospectively evaluated for immediate and short-term complications. The Fisher exact test compared incidence of complications by VTE prophylaxis. Multinomial logistic regression modeled the probability of complication by prophylaxis type, demographics, and comorbidities. Significance was set at P , .05. Results: Of the 266 patients who met inclusion criteria, 79.3% were given mechanical prophylaxis alone and 20.7% were given combined mechanical and chemical prophylaxis. Complications including VTE (0.38%), delayed wound healing or infection (2.26%), and hematoma (0.75%) were observed at rates similar to or lower than previously published studies with increased utilization of chemoprophylaxis. Use of chemoprophylaxis and continuation of perioperative aspirin were significantly associated with the development of a hemorrhagic complication. No patient developed persistent neurologic deficit from hematoma or pulmonary embolism. Conclusions: The VTE Prophylaxis Risk/Benefit Score comprehensively considers the risk of thrombotic, wound, and bleeding complications and is an effective tool for determining appropriate thromboprophylaxis in adult degenerative spinal surgery. Level of Evidence: 3.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An Evidence-Based Algorithm for Determining Venous Thromboembolism Prophylaxis After Degenerative Spinal Surgery

et al. 2020

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“…2,3 This compares to values ranging from 0.8% to 15.5% for a DVT in spine surgery patients. [4][5][6][7][8] The documented risk factors for the rare complication of epidural hematomas include prophylactic anticoagulation after spinal operation, among others, which has been associated in approximately one-third of epidural hematoma cases. 9 Though anticoagulant therapy alone likely does not initiate spontaneous epidural hematoma or spinal hemorrhage, its use represents the second most common association with epidural hematomas second only to idiopathic spinal hematoma.…”

Section: Introductionmentioning

confidence: 99%

Comparing Bleeding and Thrombotic Rates in Spine Surgery: An Analysis of 119 888 Patients

Pirkle

Cook

Kaskovich

et al. 2019

Global Spine Journal

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Study Design: Retrospective, database review. Objectives: Examine the utilization rate of postoperative deep vein thrombosis (DVT) prophylaxis and compare the incidence and severity of bleeding and thrombotic complications in elective spine surgery patients. Methods: We utilized PearlDiver, a national orthopedics claims database. All patients who underwent elective spine surgery from 2007 to 2017 were included. Patients were stratified by the presence of DVT prophylaxis drug codes, then by comorbidities for postoperative bleeding/thrombosis. The severity of all bleeding and thrombotic complications in each cohort was studied, including the incidence of complications requiring operative washout, diagnosis of pulmonary embolism, intensive care unit admission, and mortality. Results: A total of 119 888 patients were included. The majority of patients (118 720, >99%) were not administered postoperative DVT chemoprophylaxis while a minority of patients (1168) were. The overall rates of bleeding and thrombotic complications within the population not receiving DVT prophylaxis were 1.96% and 2.45%, respectively ( P < .001). The incidence of surgical intervention for a wound washout was 0.62% compared with 1.05% for pulmonary embolism ( P < .001). Intensive care unit admission rates related to a wound washout procedure or pulmonary embolism also significantly differed (0.07% vs 0.34%, P < .001). There were no observed differences in mortality. When controlling for patient comorbidity, patients with atrial fibrillation, cancer, or a prior history of thrombotic complications experienced the greatest increased risks of postoperative thrombosis. Conclusions: DVT prophylaxis is not routinely utilized following elective spine procedures. We report that there exist specific populations which may receive benefit from these practices, although further study is necessary to determine optimal prevention strategies for both thrombotic and bleeding complications in spine surgery.

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ICU Care for the Spine Patient

Romito

2022

Multidisciplinary Spine Care

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Risk factors and pharmacologic prophylaxis for venous thromboembolism in elective spine surgery

Cited by 53 publications

References 22 publications

An Evidence-Based Algorithm for Determining Venous Thromboembolism Prophylaxis After Degenerative Spinal Surgery

An Evidence-Based Algorithm for Determining Venous Thromboembolism Prophylaxis After Degenerative Spinal Surgery

Comparing Bleeding and Thrombotic Rates in Spine Surgery: An Analysis of 119 888 Patients

ICU Care for the Spine Patient

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