Prevalence and countermeasures for venous thromboembolic diseases associated with spinal surgery: a follow-up study of an institutional protocol in 209 patients

Koji Akeda, Hidetoshi Matsunaga, Takao Imanishi, Masahiro Hasegawa, Toshihiko Sakakibara, Yuichi Kasai, Akihiro Sudo
Spine 2014 May 1, 39 (10): 791-7

STUDY DESIGN: A prospective study of 209 patients undergoing spinal surgery.

OBJECTIVE: To determine the incidence of venous thromboembolic diseases, including deep venous thrombosis (DVT) and pulmonary embolism (PE), and to evaluate the effectiveness of an institutional protocol for venous thromboembolic diseases during the spinal surgery perioperative period.

SUMMARY OF BACKGROUND DATA: Although patients undergoing spinal surgery are at risk of venous thromboembolism (VTE), there are no universally accepted guidelines for VTE prophylaxis.

METHODS: Between December 2006 and January 2011, 209 patients undergoing spinal surgery (121 males, 88 females; average age: 64 yr), who also had ultrasonographic assessments of both legs before and after surgery, were prospectively assessed. A pneumatic sequential compression device and standard compression stockings were used for primary VTE prophylaxis. In Mie University Hospital protocol, pharmacological agents were not used for VTE prophylaxis after surgery. However, when a distal type DVT was found preoperatively, an anticoagulant medication was administered until 6 hours prior to surgery. After detection of DVTs, weekly ultrasonography assessed the DVT.

RESULTS: Twenty-three patients (11.0%) showed VTE in the spinal surgery perioperative period. Nine patients (4.3%) had VTE (PE with proximal DVT, 1 [0.5%]; distal DVT, 8 [3.8%]) before surgery. In the one case of asymptomatic PE with proximal DVT, an inferior vena cava filter was placed before surgery. Fourteen patients (6.7%) developed new-onset VTE (PE with proximal DVT, 2 [1.0%]; distal DVT, 12 [5.9%]) after spinal surgery. New-onset PE with proximal DVT occurred in 2 patients after surgery. Follow-up ultrasonographic assessment showed that the DVT disappeared completely in 85% (17/20) of patients with a distal type DVT during the perioperative period.

CONCLUSION: DVT assessment using ultrasonography is important for proper management of VTE during the perioperative period of spinal surgery, especially for high-risk patients, such as those with advanced age or neurological deficit. The institutional protocol for VTE using pneumatic sequential compression device and compression stockings is effective, although the administration of chemoprophylaxis should be considered for high-risk patients, such as those with spinal tumors and spinal trauma.

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