Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?

Kochai, Alauddin; Çiçekli, Özgür; Bayam, Levent; Türker, Mehmet; Sariyilmaz, Kerim; Erkorkmaz, Ünal

doi:10.1097/md.0000000000016552

Cited by 7 publications

(20 citation statements)

References 19 publications

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“…Generally, the use of deep venous thrombosis (DVT) chemoprophylaxis is not common in AIS surgery, as the use of antiembolic stockings and early mobilization have been known to be effective. [29][30][31] Prior literature even suggests that pharmacological prophylaxis after elective spine surgery does not significantly reduce the risk of DVT or pulmonary embolism but instead increases the rate of postoperative hematoma. 32 In this study, compared with patients without DVT chemoprophylaxis, patient use of anticoagulation increased the rates of perioperative blood transfusion (40% vs 31.3%), postoperative hematoma (5.5% vs 1.2%), and readmission (32.7% vs 4.1%) within 90 days.…”

Section: Discussionmentioning

confidence: 99%

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

Lee¹,

Fields²,

Boddapati³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEWith the continued evolution of bundled payment plans, there has been a greater focus within orthopedic surgery on quality metrics up to 90 days of care. Although the Centers for Medicare and Medicaid Services does not currently penalize hospitals based on their pediatric readmission rates, it is important to understand the drivers for unplanned readmission to improve the quality of care and reduce costs.METHODSThe National Readmission Database provides a nationally representative sample of all discharges from US hospitals and allows follow-up across hospitals up to 1 calendar year. Adolescents (age 10–18 years) who underwent idiopathic scoliosis surgery from 2012 to 2015 were included. Patients were separated into those with and those without readmission within 30 days or between 31 and 90 days. Demographics, operative conditions, hospital factors, and surgical outcomes were compared using the chi-square test and t-test. Independent predictors for readmissions were identified using stepwise multivariate logistic regression.RESULTSA total of 30,677 patients underwent adolescent idiopathic scoliosis surgery from 2012 to 2015. The rates of 30- and 90-day readmissions were 2.9% and 1.4%, respectively. The mean costs associated with the index admission and 30- and 90-day readmissions were $60,680, $23,567, and $16,916, respectively. Common risk factors for readmissions included length of stay > 5 days, obesity, neurological disorders, and chronic use of antiplatelets or anticoagulants. The index admission complications associated with readmissions were unintended durotomy, syndrome of inappropriate antidiuretic hormone, and superior mesenteric artery syndrome. Hospital factors, discharge disposition, and operative conditions appeared to be less important for readmission risk. The top reasons for 30-day and 90-day readmissions were wound infection (34.7%) and implant complications (17.3%), respectively. Readmissions requiring a reoperation were significantly higher for those that occurred between 31 and 90 days after the index readmission.CONCLUSIONSReadmission rates were low for both 30- and 90-day readmissions for adolescent idiopathic scoliosis surgery patients. Nevertheless, readmissions are costly and appear to be associated with potentially modifiable risk factors, although some risk factors remain potentially unavoidable.

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Section: Discussionmentioning

confidence: 99%

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

Lee¹,

Fields²,

Boddapati³

et al. 2021

Journal of Neurosurgery: Spine

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“…Length of stay was significantly shorter in the non-chemoprophylaxis group. The authors did not find a correlation between when chemoprophylaxis was initiated and the reported complications 228 .…”

Section: - Should Pediatric Patients Undergoing Major Spine Procedure...mentioning

confidence: 84%

Recommendations from the ICM-VTE: Spine

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Spine Delegates* 1 -Is routine screening for DVT required in the preoperative and/or post-operative period for patients undergoing spine procedures?Response/Recommendation: There is no role for routine screening for deep venous thrombosis (DVT) in patients undergoing spine procedures. Doppler ultrasonography surveillance may be considered in high-risk surgical patients including those who are older, with spine injury, personal history of VTE, malignancy, cervical spondylotic myelopathy (CSM), and/or non-ambulatory.Strength of Recommendation: Limited.Delegates vote: Agree 96.43% Disagree 3.57% Abstain 0.00% (Strong Consensus).Rationale: Venous thromboembolism (VTE) is a wellknown complication of major orthopaedic and spine surgeries. The reported incidence of VTE in patients undergoing spine surgery range from 0.29% -31% 1-3 . Moreover, the overall rates of pulmonary (PE) and associated fatality after spinal surgery are 1.38% and 0.34%, respectively [2][3][4][5] .Although contrast venography has been used for diagnosis of DVT, it is not suitable for the routine screening of asymptomatic patients due to potential complications, technical issues, expense, and invasiveness 6 . Similarly, the use of D-dimer, a byproduct of fibrinolysis 7 , as a screening tool lacked sensitivity and specificity in detecting VTE after hip arthroplasty [8][9][10][11][12] . Ultrasonography, on the other hand, has become the primary non-invasive method for investigating suspected DVT of the femoral and popliteal veins 9 . Standard ultrasound showed relatively high sensitivity (> 90%) for proximal or (around 60%) for below-the-knee DVT in a systematic review of diagnostic cohort studies 13 . Duplex ultrasonography (DUS) has also improved precision and efficiency in diagnosing DVT compared to most non-invasive techniques 14 . Furthermore, combined D-dimer and ultrasound screening in patients with acute spinal cord injury have improved the detection of VTE compared to D-dimer screening alone 15 .However, controversy remains regarding the use of routine screening for DVT in the perioperative period for patients undergoing spine procedures. We performed an extensive systematic review of all publications. A total of 26 articles that satisfied all inclusion criteria were selected for data extraction after full review. Information about these studies with respect to year of publication, level of evidence, number of patients, methods of screening, timing of screening, methods of prophylaxis, and incidence of VTE are summarized in Table I. Studies suggest against screening for patients undergoing spine surgery while others recognize that only patients at high risk may benefit. Based on the available literature, the risk factors for an increased risk of VTE in patients undergoing spine surgery may be seen in older patients, long periods of bedrest from paralysis and pain, high D-dimer level, longer duration of operation, intraoperative blood loss and transfusion, previous history of VTE, fracture, comorbid disease burden and tumor surgery...

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“…Finally, 10 studies were included in the review after full text screening. [25][26][27][28][29][30][31][32][33][34][35] Of the 10 included studies, two were randomized control trials (RCT), 26,27 seven were cohort studies, 25,[28][29][30][31][32][33] and one was a case-control study. 34 Regarding the quality assessment rating, three studies rated good, 27,28,34 four rated fair, 25,26,31,32 while three studies rated poor.…”

Section: Included Studiesmentioning

confidence: 99%

“…34 Regarding the quality assessment rating, three studies rated good, 27,28,34 four rated fair, 25,26,31,32 while three studies rated poor. 29,30,33 We divided the studies into three categories based on the population studied: (1) children admitted to the intensive care unit (ICU), 25,26 (2) children with fractures and/or undergoing surgery, [28][29][30][31]34 and (3) children with systemic disease, for example, congenital heart disease or cancer. 27,32,33 Characteristics and results of the included studies are presented in ►Table 1.…”

Section: Included Studiesmentioning

confidence: 99%

“…Four cohort studies and one case-control study investigated the effect of pharmacological TP in children with pelvic or femoral fractures, 31 undergoing surgery due to spine deformities, 29,30 or surgery for cardiac abnormalities. 28,34 A total of 754 children received pharmacological TP and was compared with 1,228 children who did not receive pharmacological TP.…”

Section: Children With Fractures and Children Undergoing Surgerymentioning

confidence: 99%

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Prophylaxis of Venous Thromboembolism in Children: A Systematic Review

Pedersen

Villadsen

Hellfritzsch³

et al. 2022

Semin Thromb Hemost

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Venous thromboembolism (VTE) in children is a rare but serious event. Current guidance on pharmacological thromboprophylaxis in children is mostly based on adult studies and expert opinions. The aim of this systematic review was to examine under which conditions children (age ≤ 18 years) would benefit from pharmacological thromboprophylaxis with low molecular weight heparin or unfractionated heparin. Eligible studies included children, who did not receive pharmacological thromboprophylaxis as comparator, and VTE events were radiologically verified. MEDLINE and Embase were searched up to October 3, 2021. Ten studies were included presenting data for 976 children receiving pharmacological thromboprophylaxis. We divided the studies into three categories based on the population studied: children in the intensive care unit (n = 2), children with fractures and/or undergoing surgery (n = 5), and children with systemic disease (n = 3). A lower incidence of VTE was found when pharmacological thromboprophylaxis was used compared with no prophylaxis in children in intensive care unit with central venous catheter and mechanical ventilation (7/27 vs. 13/24), children in the intensive care unit admitted after trauma with a very high risk of VTE based on several risk factors (0/21 vs. 13/96), and children with acute lymphoblastic leukemia treated with L-asparaginase concomitant with steroid and presence of central venous catheter (0/82 vs. 8/121). Pharmacological thromboprophylaxis was not associated with an increased bleeding risk. In conclusion, pharmacological thromboprophylaxis in children is sparsely investigated. Only children with several risk factors for VTE are likely to benefit from pharmacological thromboprophylaxis.

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Is pharmacological anticoagulant prophylaxis necessary for adolescent idiopathic scoliosis surgery?

Cited by 7 publications

References 19 publications

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

The risks, reasons, and costs for 30- and 90-day readmissions after fusion surgery for adolescent idiopathic scoliosis

Recommendations from the ICM-VTE: Spine

Prophylaxis of Venous Thromboembolism in Children: A Systematic Review

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