Incidence of deep vein thrombosis after major spine surgeries with no mechanical or chemical prophylaxis

ABSTRACT

Study design: Retrospective cohort study.

Clinical question: What is the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after major spine surgery when no prophylactic measures were used?

Methods: A prospective evaluation of 121 patients who underwent 128 major spine surgeries was conducted to determine the incidence of clinically identifiable DVT. As a matter of practice, no patient was given thromboprophylaxis, either mechanical or chemical.

Results: Only one patient developed the signs and symptoms of DVT, which was further confirmed by a Doppler study. The overall incidence of DVT was 0.78%. There was no clinically evident case of PE.

Conclusions: Considering the low rate of incidence of DVT and PE, routine screening and prophylaxis for DVT appears unwarranted in major spine surgery.

Final class of evidence—prognosis
Study design
Prospective cohort
Retrospective cohort	•
Case control
Case series
Methods
Patients at similar point in course of treatment	•
F/U ≥ 85%
Similarity of treatment protocols for patient groups	•
Patients followed up long enough for outcomes to occur	•
Control for extraneous risk factors
Overall class of evidence	III

The definiton of the different classes of evidence is available here.

• REFERENCES

• 1 Geerts WH, Bergqvist D, Pineo GF et al. 2008; Prevention of venous thromboembolism: American College of Chest Physicians, evidence-based clinical practice guidelines. (8th Edition).. Chest 133 (Suppl. 06) 381S-453S
• 2 Ploumis A, Ponnappan RK, Sarbello J et al. 2010; Thromboprophylaxis in traumatic and elective spinal surgery: analysis of questionnaire response and current practice of spinal surgeons. Spine (Phila Pa 1976) 35 (3) 323-329
• 3 Cheng JS, Arnold PM, Anderson PA et al. 2010; Anticoagulation risk in spine surgery. Spine (Phila Pa 1976) 35 (Suppl. 09) S117-124
• 4 Committee NE-BGD. 2009. Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care. In: Antithrombotic Therapies in Spine Surgery.. Burr Ridge, Ill: North American Spine Society;
• 5 Epstein NE. 2006; Efficacy of pneumatic compression stocking prophylaxis in the prevention of deep venous thrombosis and pulmonary embolism following 139 lumbar laminectomies with instrumented fusions. J Spinal Disord Tech 19 (1) 28-31
• 6 Lee HM, Suk KS, Moon SH et al. 2000; Deep vein thrombosis after major spinal surgery: incidence in an East Asian population. Spine (Phila Pa 1976) 25 (14) 827-1830
• 7 Schuster JM, Fischer D, Dettori JR. 2010; Is chemical antithrombotic prophylaxis effective in elective thoracolumbar spine surgery? Results of a systematic review. EBSJ 1 (2) 41-46
• 8 Smith JS, Fu KM, Polly Jr DW et al. 2010; Complication rates of three common spine procedures and rates of thromboembolism following spine surgery based on 108,419 procedures: a report from the Scoliosis Research society Morbidity and Mortality Committee. Spine (Phila Pa 1976) 35 (24) 2140-2149