Venous thromboembolism in adult elective spinal surgery

Fawi, Hassan; Saba, Karim; Cunningham, Aaron J.; Masud, Sarwat; Lewis, MH; Hossain, Munier; Chopra, I.; Ahuja, Sashin

doi:10.1302/0301-620x.99b9.bjj-2016-1193.r2

Cited by 21 publications

(13 citation statements)

References 19 publications

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“…There were not any significant statistical differences in the 2 groups. [19] In the present study, although there was no statistical difference between the groups for superficial SSI, there was no superficial or deep infection in Group C of our study. However, 3 patients in Group B and 3 patients in Group A presented with superficial SSI.…”

Section: Discussioncontrasting

confidence: 62%

Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?

et al. 2019

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We report the outcomes of mechanical prophylaxis and chemoprophylaxis in patients who underwent elective surgery for idiopathic adolescent scoliosis (AIS). We retrospectively studied the patients who underwent posterior spinal instrumentation for AIS. The patients were divided into three groups: Group A low-molecular-weight heparin (LMWH) started at 8 hours after surgery; Group B LMWH started at 24 hr after surgery; Group C did not receive chemoprophylaxis. The data about wound oozing, need for transfusion, preoperative and postoperative hemoglobin level, length of stay in hospital, interval from the surgery to removal of closed suction drainage tube, postoperative blood loss from closed suction drain, deep venous thrombosis (DVT), and pulmonary embolism (PE) were investigated. The mean age and Lenke classification for all the groups were similar. No DVT or PE was detected in any group. The mean blood loss from the drain was higher in Group A (400 mL) and Group B (450 mL) when compared to Group C (150 mL) ( P = .001). There were more wound oozing in Groups A (5) and B (6) than in Group C (3) ( P = .585). Three patients in Group B, 3 patients in Group A, and no patient in Group C had superficial infections. However, there was no statistical difference between the groups ( P = .182). Postoperative hospital stay was significantly longer in Groups A (6 days) and B (6 days) then in Group C (5 days) ( P = .001). Our current study claims that chemoprophylaxis is not necessary for the patients without risk factors after AIS surgery. Early mobilization and mechanoprophylaxis represents adequate prophylaxis in addition to pain management and well hydration in patients’ routine treatment. The complications of chemoprophylaxis are not correlated to the initiation time of prophylaxis.

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Section: Discussioncontrasting

confidence: 62%

Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?

et al. 2019

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“…The overall rate of venous thromboembolism after elective spine surgery is 0.5% to 1.1%. [240][241][242] Factors associated with postoperative venous thromboembolism include: (1) preoperative factors such as dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race; (2) intraoperative factors such as surgery duration > 4 hours, emergency presentation, ASA III or greater, intraoperative blood loss > 2000 mL, use of packed red blood cell transfusion, deep surgical site infection; and (3) postoperative factors including postoperative sepsis. The addition of low-molecular-weight heparin decreases the incidence of venous thromboembolism compared with mechanical prophylaxis alone (0% vs. 0.59%), 242 with no reported cases of epidural hematoma.…”

Section: Venous Thromboembolism Prophylaxismentioning

confidence: 99%

“…[240][241][242] Factors associated with postoperative venous thromboembolism include: (1) preoperative factors such as dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race; (2) intraoperative factors such as surgery duration > 4 hours, emergency presentation, ASA III or greater, intraoperative blood loss > 2000 mL, use of packed red blood cell transfusion, deep surgical site infection; and (3) postoperative factors including postoperative sepsis. The addition of low-molecular-weight heparin decreases the incidence of venous thromboembolism compared with mechanical prophylaxis alone (0% vs. 0.59%), 242 with no reported cases of epidural hematoma. 242 Recommendation: (1) To reduce the incidence of perioperative venous thromboembolic complications, nonchemical prophylaxis in the form of sequential compression devices may be applied before induction of general anesthesia and continued until chemical prophylaxis is promptly initiated in the postoperative period (Class I, Level of Evidence C-EO).…”

Section: Venous Thromboembolism Prophylaxismentioning

confidence: 99%

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

Blacker

Vincent

Burbridge

et al. 2021

Journal of Neurosurgical Anesthesiology

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Evidence-based standardization of the perioperative management of patients undergoing complex spine surgery can improve outcomes such as enhanced patient satisfaction, reduced intensive care and hospital length of stay, and reduced costs. The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) tasked an expert group to review existing evidence and generate recommendations for the perioperative management of patients undergoing complex spine surgery, defined as surgery on 2 or more thoracic and/or lumbar spine levels. Institutional clinical management protocols can be constructed based on the elements included in these clinical practice guidelines, and the evidence presented.

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“…Deep vein thrombosis (DVT) and pulmonary embolism (PE) are recognized complications after spine surgery, with rates in the literature ranging from 0% to 14% with some form of prophylaxis. [1][2][3] Venous thromboembolism (VTE) can result in associated morbidity and mortality and, as a consequence, numerous organizations have suggested guidelines to address the issue. [4][5][6] However, there is a relative paucity of information available regarding the relative incidence of VTE complications for specific antithrombotic prophylactic measures within specific spine surgery patient subpopulations, such as patients undergoing anterior lumbar interbody fusion (ALIF) surgery.…”

Section: Introductionmentioning

confidence: 99%

The Incidence of Venous Thromboembolism in Patients Undergoing Anterior Lumbar Interbody Fusion: A Proposed Thromboprophylactic Regime

et al. 2021

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Objective: To determine the safety and efficacy of the proposed venous thromboembolism (VTE) prophylaxis regime in patients undergoing anterior lumbar interbody fusion (ALIF) surgery.Background: Deep vein thrombosis (DVT) and pulmonary embolism (PE) are recognized complications after spine surgery, with rates in the literature ranging from 0% to 14% with some form of prophylaxis. Pharmacological thromboprophylaxis can cause postoperative bleeding and hematomas, which can result in significant neural compromise or permanent injury, and wound complications. ALIF surgery involves the handling and compression of major abdominal vessels during surgery and this adds to the risk of both arterial thrombosis and VTE.Methods: A retrospective review of data, which were prospectively collected to evaluate the incidence of VTE in 200 consecutive patients undergoing ALIF following our VTE prophylaxis protocol. All patients had low molecular weight heparin, tinzaparin 4500 units subcutaneously on the evening before surgery, then daily for 3 to 5 days, then aspirin (acetylsalicylic acid) 150 mg daily plus lansoprazole 30 mg daily for 4 weeks after surgery. All patients had intermittent pneumatic compression of their calves and thighs intraoperatively and for 24 hours postoperatively then had early mobilization and thromboembolic deterrent stockings for 6 weeks.Results: There was no incidence of any symptomatic VTE in the any of the 200 patients and no loss to follow-up. There was a 0% incidence of injury to the iliac vessels, symptomatic arterial occlusion, wound hematoma, major intraoperative bleeding, need for transfusion, symptomatic GI bleed, or retroperitoneal hematoma requiring intervention.Conclusions: The proposed VTE prophylactic regime is safe and efficacious and may decrease the incidence of symptomatic VTE in patients undergoing an ALIF procedure, and despite the use of chemical thromboprophylaxis, there is no evidence of bleeding complications as a result of using this regime.Level of Evidence: 4.

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Venous thromboembolism in adult elective spinal surgery

Cited by 21 publications

References 19 publications

Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?

Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?

Perioperative Care of Patients Undergoing Major Complex Spinal Instrumentation Surgery: Clinical Practice Guidelines From the Society for Neuroscience in Anesthesiology and Critical Care

The Incidence of Venous Thromboembolism in Patients Undergoing Anterior Lumbar Interbody Fusion: A Proposed Thromboprophylactic Regime

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