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Thromboprophylaxis in spinal surgery: a survey
David J Bryson1, Chika E Uzoigwe, Jason Braybrooke
1Department of Trauma and Orthopaedics, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK. davidjbryson@hotmail.com
Journal of Orthopaedic Surgery and Research
|March 31, 2012
Summary
Neurosurgical and orthopedic surgeons differ in preventing venous thromboembolism (VTE) after spinal surgery. Neurosurgeons more closely follow national guidelines for VTE prophylaxis, indicating a need for consensus.
Area of Science:
- Spinal Surgery
- Thromboprophylaxis
- Epidemiology
Background:
- Venous Thromboembolism (VTE) is a common complication after major joint surgery, but data on its incidence after spinal surgery is limited.
- Existing evidence suggests a higher prevalence of deep vein thrombosis (DVT) post-spinal surgery than commonly recognized.
- Lack of epidemiological data hinders the development of optimal VTE prophylaxis guidelines for spinal procedures.
Purpose of the Study:
- To investigate current trends in VTE thromboprophylaxis practices within spinal surgery.
- To assess adherence to National Institute for Health and Clinical Excellence (NICE) guidelines among spinal surgeons.
- To compare thromboprophylaxis choices between orthopaedic and neurosurgical specialists.
Main Methods:
- A questionnaire was developed with eight clinical scenarios to assess thromboprophylaxis choices.
- Participants provided details on their surgical specialty.
- Chi-squared analysis was used to statistically compare responses between different surgical disciplines.
Main Results:
- Neurosurgical respondents were more likely to use low molecular weight heparin (73%) compared to orthopaedic surgeons (31%).
- Neurosurgery favored anti-embolism stockings (79%) more than orthopaedic surgery (50%), while orthopaedic surgeons preferred mechanical prophylaxis (26% vs. 9%).
- No significant differences in prophylaxis choices were observed between trauma and non-trauma scenarios.
Conclusions:
- There is a lack of consensus regarding VTE thromboprophylaxis in spinal surgery.
- Significant differences exist in prophylaxis selections between surgical specialties, with neurosurgeons demonstrating closer adherence to national guidelines.
- Further research into the epidemiology of VTE in spinal surgery and the risk-benefit profile of thromboprophylaxis is essential.
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