Surgeon practices regarding postoperative thromboembolic prophylaxis after high-risk spinal surgery

Area of Science:

• Spine Surgery
• Thromboembolic Prophylaxis
• Surgical Outcomes

Background:

• Thromboembolic prophylaxis is recommended for high-risk spine surgery patients (tumors, trauma), but lacks established guidelines.
• Surgeons face decisions on prophylaxis methods and timing due to limited efficacy and safety data.
• No prior studies have examined current thromboembolic prophylaxis practices in this specific surgical population.

Purpose of the Study:

• To assess current practices of thromboembolic prophylaxis among spine surgeons.
• To evaluate surgeon approaches to prophylaxis timing, agents, and Inferior Vena Cava (IVC) filter use in high-risk spine surgery.

Main Methods:

• A survey study involving 193 orthopaedic and neurosurgical spine surgeons specializing in tumor or trauma surgery.
• An online questionnaire assessed perceptions of deep venous thrombosis (DVT), pulmonary embolism (PE), and epidural hematoma risks.
• Questions covered preferred chemoprophylactic agents, safe initiation times, and IVC filter usage.

Main Results:

• A 49% response rate (94 surgeons) revealed wide variability in prophylaxis timing, with 48 hours being the most common but diverse responses.
• Sixty-three percent of surgeons based decisions on personal experience rather than evidence; low-molecular-weight heparin was the preferred agent.
• Perceived risks of epidural hematoma and DVT influenced prophylaxis timing, and IVC filters were often placed preoperatively.

Conclusions:

• Significant variability exists in surgeons' thromboembolic prophylaxis practices for high-risk spine surgery.
• This variability stems from a lack of robust scientific evidence on risks and prophylaxis efficacy/safety.
• There is a clear need for prospective studies to establish evidence-based guidelines for thromboembolic prophylaxis in these patients.