Deep Venous Thrombosis After Spinal Surgery

Ferree, Bret A.; Stern, Peter J.; Jolson, R S; Th, Just; Kahn, A

doi:10.1097/00007632-199303000-00001

Cited by 83 publications

(44 citation statements)

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“…18,19 The incidence of VTE after spine surgery is poorly defined and highly variable, with published rates ranging from 0.3% to 31%. 6,[9][10][11]28,32,35 This high variance is likely due to heterogeneities of the studied patient populations as well as to inconsistent treatment practices and diagnostic measures.…”

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confidence: 99%

Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Cox¹,

Weaver²,

Neal³

et al. 2014

SPI

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Object Venous thromboembolism (VTE) represents a significant complication after spine surgery, with reported rates as high as 2%–4%. Published institutional practices for VTE prophylaxis are highly variable. In 2008, the authors implemented a departmental protocol for early VTE prophylaxis consisting of combined compressive devices and subcutaneous heparin initiated either preoperatively or on the same day of surgery. In this study, the authors compared the incidence of VTE in spine surgery patients before and after implementing this protocol. Methods An institutional review board–approved retrospective review of outcomes in patients undergoing spine surgery 2 years before protocol implementation (representing the preprotocol group) and of outcomes in patients treated 2 years thereafter (the postprotocol group) was conducted. Inclusion criteria were that patients were 18 years or older and had been admitted for 1 or more days. Before 2008 (preprotocol), VTE prophylaxis was variable and provider dependent without any uniform protocol. Since 2008 (postprotocol), a new VTE-prophylaxis protocol was administered, starting either preoperatively or on the same day of surgery and continuing throughout hospitalization. The new protocol consisted of 5000 U heparin administered subcutaneously 3 times daily, except in patients older than 75 years or weighing less than 50 kg, who received this dose twice daily. All patients also received sequential compression devices (SCDs). The incidence of VTE in the 2 protocol phases was identified by codes of the International Classification of Diseases, Ninth Revision (ICD-9) codes for deep vein thrombosis (DVT) and pulmonary embolus (PE). Bleeding complications arising from anticoagulation treatments were evaluated by the Current Procedural Terminology (CPT) code for postoperative epidural hematoma (EDH) requiring evacuation. Results In total, 941 patients in the preprotocol group met the inclusion criteria: 25 had DVT (2.7%), 6 had PE (0.6%), and 6 had postoperative EDH (0.6%). In the postprotocol group, 992 patients met the criteria: 10 had DVT (1.0%), 5 had PE (0.5%), and 4 had postoperative EDH (0.4%). This reduction in DVT after the protocol's implementation was statistically significant (p = 0.009). Despite early aggressive prophylaxis, the incidence of postoperative EDH did not increase and compared favorably to the published literature. Conclusions At a high-volume tertiary center, an aggressive protocol for early VTE prophylaxis after spine surgery decreases VTE incidence without increasing morbidity.

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confidence: 99%

Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis

Cox¹,

Weaver²,

Neal³

et al. 2014

SPI

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“…In several articles, 32,34,33 Ferree described the use of mechanical prophylaxis and found no significant statistical difference in rates of VTE, while in his prospective study, Epstein 22 showed that intermittent pneumatic compression is effective in prophylaxis against VTE/PTE. Smith et al, 31 using a combination of elastic compression stockings and intermittent pneumatic compression, found no evidence of thrombosis in any of the 126 duplex ultrasound studies, and reported an overall clinical prevalence of thrombotic complications of 0.9% (3 patients in 317).…”

Section: Resultsmentioning

confidence: 99%

Up-to-date thromboprophylaxis in elective spinal surgery. A systematic review

2014

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Deep vein thrombosis (DVT) and pulmonary embolism (PE) present a high incidence after surgery, posing a high risk in surgical practice. Although a consensus does exist on thromboprophylaxis in orthopedic surgery, this topic remains controversial in regard to spinal surgery. In this current paper, we review and discuss the different forms of prophyilaxis presented in literature, in order to develop guidelines on prophylactic measures in spinal surgery, improving patient´s outcomes and reducing any medical/legal problems that could arise from a thrombotic complication.

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“…Considerable progress has been made in risk assessment and prophylaxis for deep venous thrombosis (DVT) and PE after arthroplasty and trauma surgery [1]. Although a review of the literature indicates that such thromboembolic phenomenon may complicate spine surgery, there is limited information regarding the risks and possible prevention [2][3][4]. The case presented is of interest in a number of respects, specifically the magnitude of the pulmonary embolism, its early (post-op day 1) occurrence, and its occurrence at all given the previously implanted IVC filter.…”

Section: Discussionmentioning

confidence: 99%