STUDY DESIGN: Systematic review of the literature and analysis of pooled data. OBJECTIVES: To better understand the incidence of thromboembolic disease in postoperative spinal patients, and to establish a starting point for defining appropriate postoperative prophylaxis protocols. SUMMARY OF BACKGROUND DATA: The risk of thromboembolic disease is well studied for some orthopedic procedures. However, the incidence of postoperative thromboembolic disease is less well-defined in patients who have had spinal surgery. METHODS: The MEDLINE database was queried using the search terms deep venous thrombosis or DVT, pulmonary embolus, thromboembolic disease, and spinal or spine surgery. Abstracts of all identified articles were reviewed. Detailed information from eligible articles was extracted. Data were compiled and analyzed by simple summation methods when possible to stratify rates of DVT and/or pulmonary embolus for a given prophylaxis protocol, screening method, and type of spinal surgery. RESULTS: Twenty-five articles were eligible for full review. DVT risk ranged from 0.3% to 31%, varying between patient populations and methods of surveillance. Pooling data from the 25 studies, the overall rate of DVT was 2.1%. DVT rate was influenced by prophylaxis method: no prophylaxis, 2.7%; compression stockings (CS), 2.7%; pneumatic sequential compression device (PSCD), 4.6%; PSCD and CS, 1.3%; chemical anticoagulants, 0.6%; and inferior vena cava filters with/without another method of prophylaxis, 22%. DVT rate was also influenced by the method of diagnosis, ranging from 1% to 12.3%. CONCLUSION: As risk of DVT after routine elective spinal surgery is fairly low, it seems reasonable to use CS with PSCD as a primary method of prophylaxis. There is insufficient evidence to support or refute the use of chemical anticoagulants in routine elective spinal surgery. In addition, there is insufficient evidence to suggest that screening patients undergoing elective spinal surgery with ultrasound or venogram is routinely warranted.
STUDY DESIGN: Systematic review of the literature and analysis of pooled data. OBJECTIVES: To better understand the incidence of thromboembolic disease in postoperative spinal patients, and to establish a starting point for defining appropriate postoperative prophylaxis protocols. SUMMARY OF BACKGROUND DATA: The risk of thromboembolic disease is well studied for some orthopedic procedures. However, the incidence of postoperative thromboembolic disease is less well-defined in patients who have had spinal surgery. METHODS: The MEDLINE database was queried using the search terms deep venous thrombosis or DVT, pulmonary embolus, thromboembolic disease, and spinal or spine surgery. Abstracts of all identified articles were reviewed. Detailed information from eligible articles was extracted. Data were compiled and analyzed by simple summation methods when possible to stratify rates of DVT and/or pulmonary embolus for a given prophylaxis protocol, screening method, and type of spinal surgery. RESULTS: Twenty-five articles were eligible for full review. DVT risk ranged from 0.3% to 31%, varying between patient populations and methods of surveillance. Pooling data from the 25 studies, the overall rate of DVT was 2.1%. DVT rate was influenced by prophylaxis method: no prophylaxis, 2.7%; compression stockings (CS), 2.7%; pneumatic sequential compression device (PSCD), 4.6%; PSCD and CS, 1.3%; chemical anticoagulants, 0.6%; and inferior vena cava filters with/without another method of prophylaxis, 22%. DVT rate was also influenced by the method of diagnosis, ranging from 1% to 12.3%. CONCLUSION: As risk of DVT after routine elective spinal surgery is fairly low, it seems reasonable to use CS with PSCD as a primary method of prophylaxis. There is insufficient evidence to support or refute the use of chemical anticoagulants in routine elective spinal surgery. In addition, there is insufficient evidence to suggest that screening patients undergoing elective spinal surgery with ultrasound or venogram is routinely warranted.
Authors: Olivier Q Groot; Paul T Ogink; Nuno Rei Paulino Pereira; Marco L Ferrone; Mitchell B Harris; Santiago A Lozano-Calderon; Andrew J Schoenfeld; Joseph H Schwab Journal: Clin Orthop Relat Res Date: 2019-07 Impact factor: 4.176
Authors: Juan José Yepes-Nuñez; Anita Rajasekhar; Maryam Rahman; Philipp Dahm; David R Anderson; Luis Enrique Colunga-Lozano; Stephanie Ross; Meha Bhatt; Kelly Estrada Orozco; Federico Popoff; Matthew Ventresca; Angela M Barbara; Sara Balduzzi; Housne Begum; Arnav Agarwal; Wojtek Wiercioch; Robby Nieuwlaat; Gian Paolo Morgano; Holger J Schünemann Journal: Blood Adv Date: 2020-06-23
Authors: Ian A Buchanan; Michelle Lin; Daniel A Donoho; Li Ding; Steven L Giannotta; Frank Attenello; William J Mack; John C Liu Journal: World Neurosurg Date: 2019-01-23 Impact factor: 2.104
Authors: Paul Nyquist; Cynthia Bautista; Draga Jichici; Joseph Burns; Sanjeev Chhangani; Michele DeFilippis; Fernando D Goldenberg; Keri Kim; Xi Liu-DeRyke; William Mack; Kim Meyer Journal: Neurocrit Care Date: 2016-02 Impact factor: 3.210
Authors: David R Anderson; Gian Paolo Morgano; Carole Bennett; Francesco Dentali; Charles W Francis; David A Garcia; Susan R Kahn; Maryam Rahman; Anita Rajasekhar; Frederick B Rogers; Maureen A Smythe; Kari A O Tikkinen; Adolph J Yates; Tejan Baldeh; Sara Balduzzi; Jan L Brożek; Itziar Etxeandia- Ikobaltzeta; Herman Johal; Ignacio Neumann; Wojtek Wiercioch; Juan José Yepes-Nuñez; Holger J Schünemann; Philipp Dahm Journal: Blood Adv Date: 2019-12-10