A new study published in The Spine Journal examines how prophylaxis guidelines affect venous thromboembolism in patients who undergo elective spine surgery.
The study authors examined 109,609 patients in the National Surgical Quality Improvement Program database who underwent elective spine surgery from 2005 to 2014 as well as data from 2,855 patients who underwent spine surgery at a single institution.
Study authors found:
1. Independent risk factors for VTE among elective spine surgery patients include:
● Older age
● Male sex
● Higher body mass index
● Dependent functional status
● Lumbar spine surgery
● Longer operative times
● Perioperative blood transfusion
● Longer length of stay
● Other postoperative complications
2. Among the 2,855 patients who underwent spine surgery at a single institution, 56.3 percent received pharmacologic prophylaxis; 97.1 percent of those patients received unfractionated heparin.
3. Patients who received the pharmacologic prophylaxis had a similar rate of VTE as those who did not, but the pharmacologic prophylaxis was associated with increased instances of hematoma that required a return to the operating room.
4. The study authors concluded: "This raises questions about routine use of unfractured heparin for VTE prophylaxis and supports the need for further consideration of risks and benefits of chemoprophylaxis after elective spine surgery."