H M T Fawi 1 , K Saba 1 , A Cunningham 1 , S Masud 1 , M Lewis 1 , M Hossain 1 , I Chopra 1 , S Ahuja 1 Show Affiliations »
Abstract
AIMS: To evaluate the incidence of primary venous thromboembolism (VTE), epidural haematoma, surgical site infection (SSI), and 90-day mortality after elective spinal surgery, and the effect of two protocols for prophylaxis. PATIENTS AND METHODS: A total of 2181 adults underwent 2366 elective spinal procedures between January 2007 and January 2012. All patients wore anti-embolic stockings, mobilised early and were kept adequately hydrated. In addition, 29% (689) of these were given low molecular weight heparin (LMWH) while in hospital. SSI surveillance was undertaken using the Centers for Disease Control and Prevention criteria. RESULTS: In patients who only received mechanical prophylaxis, the incidence of VTE was 0.59% and that of SSI 2.1%. In patients who were additionally given LMWH, the incidence of VTE was 0% and that of SSI 0.7%. The unadjusted p-value was 0.04 for VTE and 0.01 for SSI. There were no cases of epidural haematoma or 90-day mortality in either group. When adjusted for case-mix, LMWH remained a significant factor (p = 0.006) for VTE, but not for SSI. CONCLUSION: A peri-operative protocol involving mechanical anti-embolism stockings, adequate hydration, and early post-operative mobilisation is effective in significantly reducing the incidence of VTE. The addition of LMWH is safe in patients at higher risk of developing VTE. Cite this article: Bone Joint J 2017;99-B:1204-9. ©2017 The British Editorial Society of Bone & Joint Surgery.
AIMS: To evaluate the incidence of primary venous thromboembolism (VTE ), epidural haematoma, surgical site infection (SSI), and 90-day mortality after elective spinal surgery, and the effect of two protocols for prophylaxis. PATIENTS AND METHODS: A total of 2181 adults underwent 2366 elective spinal procedures between January 2007 and January 2012. All patients wore anti-embolic stockings, mobilised early and were kept adequately hydrated. In addition, 29% (689) of these were given low molecular weight heparin (LMWH ) while in hospital. SSI surveillance was undertaken using the Centers for Disease Control and Prevention criteria. RESULTS: In patients who only received mechanical prophylaxis, the incidence of VTE was 0.59% and that of SSI 2.1%. In patients who were additionally given LMWH , the incidence of VTE was 0% and that of SSI 0.7%. The unadjusted p-value was 0.04 for VTE and 0.01 for SSI. There were no cases of epidural haematoma or 90-day mortality in either group. When adjusted for case-mix, LMWH remained a significant factor (p = 0.006) for VTE , but not for SSI. CONCLUSION: A peri-operative protocol involving mechanical anti-embolism stockings, adequate hydration, and early post-operative mobilisation is effective in significantly reducing the incidence of VTE . The addition of LMWH is safe in patients at higher risk of developing VTE . Cite this article: Bone Joint J 2017;99-B:1204-9. ©2017 The British Editorial Society of Bone & Joint Surgery.
Entities: Chemical
Disease
Species
Keywords:
Deep vein thrombosis; Elective spinal operations; Epidural haematoma; Low-molecular-weight heparin; Pulmonary embolism; Venous thromboembolism
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Year: 2017
PMID： 28860401 DOI： 10.1302/0301-620X.99B9.BJJ-2016-1193.R2
Source DB: PubMed Journal: Bone Joint J ISSN： 2049-4394 Impact factor: 5.082