Case series of elective instrumented posterior lumbar spinal fusions demonstrating a low incidence of venous thromboembolism

Weber, Benjamín; Seal, Alexa; McGirr, Joseph; Fielding, Kerin

doi:10.1111/ans.12702

Cited by 16 publications

(14 citation statements)

References 17 publications

(24 reference statements)

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“…The use of chemoprophylaxis is more controversial. Some retrospective studies show that chemoprophylaxis is effective in reducing VTE [254−257], while other studies show no benefit [245,258,259]. One meta-analysis, based on 28 studies, showed that elective spinal surgery is associated with a low risk of VTE [245].…”

Section: Prophylaxis Against Thromboembolismmentioning

confidence: 99%

“…One meta-analysis, based on 28 studies, showed that elective spinal surgery is associated with a low risk of VTE [245]. In this context, chemoprophylaxis may not be warranted, given the definable risk of postoperative epidural hematoma formation and other complications [254,259]. Chemoprophylaxis may be more appropriately used in high-risk patients, such as those with advanced age, neurological deficits, history of VTEs, and those undergoing surgery for spinal deformity, trauma, and metastatic bone disease [260−266].…”

Section: Prophylaxis Against Thromboembolismmentioning

confidence: 99%

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Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

et al. 2021

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BACKGROUND: Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE: This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program.FDA device/drug status: not applicable.

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Section: Prophylaxis Against Thromboembolismmentioning

confidence: 99%

Section: Prophylaxis Against Thromboembolismmentioning

confidence: 99%

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

et al. 2021

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“…5 The score has been extensively validated in multiple surgical subspecialties. 6 7 8 9 10 11 The implementation of an individualized VTE prevention strategy based on the original health care provider–completed CRS has lowered the incidence of postoperative VTE. 12 The American College of Chest Physicians (ACCP 9th edition) recommends the use of the CRS as one method for the risk assessment of nonorthopaedic surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Patient-Completed Caprini Risk Score for Venous Thromboembolism Risk Assessment

Fuentes

Paz

Al‐Ogaili

et al. 2017

TH Open

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Introduction Individualized risk assessment for venous thromboembolism (VTE) using the Caprini risk score (CRS), coupled with targeted prophylaxis based on the score, is effective in reducing postoperative VTE. Critics contend that using this tool is time consuming for health care providers. We decided to create a patient-completed CRS and conducted a prospective study to compare the scores calculated by a patient with those calculated by a blinded physician for the same patient. Methods In phase 1, we interviewed patients in our deep vein thrombosis (DVT) support group who had a history of thrombosis and included their family members to determine areas of misunderstanding in the original CRS. We created a patientcompleted form based on these interviews. In phase 2, we further optimized the questions after a CRS-trained, blinded physician scored 20 hospitalized patients during the pilot study. In the final (third) phase, we measured the agreement level between the new form filled out by the trained physicians and those filled out by the patients. The study was approved by our local institutional review board. Using PASS version 11, we determined that a sample size of 37 individuals achieves a power of 80%, to detect a 0.1 difference between the null hypothesis correlation of 0.5 and the alternative hypothesis correlation of 0.7 using a two-sided hypothesis test with a significance level of 0.05. We tabulated the individuals' answers and categorized the scores by using SPSS version 23 to estimate the kappa value, linear correlation, and the Bland-Altman test. A kappa value greater than 0.8 indicated an "almost perfect agreement." Results We tested the first patient-completed CRS version (phase 2) in a 20-patient pilot study. A poor agreement was observed with the body mass index (BMI) responses in multiple iterations, and so we excluded the BMI calculation from the final patientcompleted CRS form. We recruited 42 patients with an average age of 55, mostly female (45%), who completed less than college education (62%) to fill out the updated CRS form

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“…Among the existent VTE risk assessment models, the 2005 Caprini risk score (CRS) is the most widely used and validated model. 9 –15 It weights independent risk factors for the individual, summing up a total score that correlates with the risk of postoperative VTE. 16 Implementation of the CRS has lowered the incidence of postoperative VTE; in fact, the 9th American College of Chest Physician (ACCP) guidelines recommend the use of this model for risk stratification in nonorthopedic surgical patients.…”

Section: Introductionmentioning

confidence: 99%

Validation of a Patient-Completed Caprini Risk Assessment Tool for Spanish, Arabic, and Polish Speakers

Rios

Fuentes

Oramas

et al. 2017

Clin Appl Thromb Hemost

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Targeted prophylaxis for venous thromboembolism (VTE) using the Caprini risk score (CRS) is effective reducing postoperative VTE. Despite its availability as preventive strategy, risk scoring remains underutilized. Critics to the CRS contend the time it takes to complete, and its limitation to English language. Aim is to create and validate patient-completed CRS tools for Spanish, Arabic, and Polish speakers. We translated the first patient-completed CRS to Spanish, Arabic, and Polish. We conducted a pilot study followed by the validation study. Using PASS version 11, we determined that a sample size of 37 achieved a power of 80%, to detect a difference of 0.1 between the null hypothesis correlation of 0.5 and the alternative hypothesis correlation of 0.7 using a 2-sided hypothesis test, significance level of .05. We tabulated and categorized scores using SPSS version 23 to estimate k, linear correlation, and Bland Altman test. k value >0.8 was defined as "almost perfect agreement." From 129 recruited patients, 50 (39%) spoke Spanish, 40 (31%) spoke Arabic, and 39 (30%) spoke Polish; average age 51 (16.69) years, 58 (45%) were men, with less than college education (67%). Mean (standard deviation) CRS was 5 (3.90), the majority (63%) above moderate VTE risk. We report excellent agreement comparing physician and patient results (k ¼ 0.93) and high correlation 0.97 (P < .01) for the overall score. Bland Altman did not show trend for extreme values. We created and validated the first Spanish, Arabic, and Polish versions of the patient-completed CRS, with excellent correlation and agreement when compared to CRS-trained physician-completed form. Based on these results, the physician needs to calculate the body mass index. Completing the form was not time-consuming.

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Case series of elective instrumented posterior lumbar spinal fusions demonstrating a low incidence of venous thromboembolism

Cited by 16 publications

References 17 publications

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Validation of a Patient-Completed Caprini Risk Score for Venous Thromboembolism Risk Assessment

Validation of a Patient-Completed Caprini Risk Assessment Tool for Spanish, Arabic, and Polish Speakers

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