Introduction: Venous thromboembolism (VTE) following spinal surgery has been identified as a significant source of morbidity. Using anti-coagulant therapy is a well-established measure against these serious complications. Surgeons often avoid early use of chemoprophylaxis due to the risk of spinal epidural hematomas. We report our experience with timing and risks of chemoprophylaxis following spinal surgery.
Methods: Records from 6870 consecutive spinal surgeries at one institution were respectively reviewed. Data was collected pertaining to patient demographics, surgery, hospital course, timing of chemoprophylaxis, and complications including DVTs, PEs, and spinal epidural hematomas requiring surgical evacuation. Patients receiving anti-coagulant therapy from one day before to three days after surgery (prophylactic group; n=1904) were compared to the remaining patients (non-prophylactic group; n=4968). The incidence of VTEs and spinal epidural hematomas were compared between these groups.
Results: Patients receiving chemoprophylaxis were older, had multiple comorbidities, underwent longer surgeries, and spent more time in the ICU. Chemoprophylaxis was started following 1.46 days on average. The rate of pulmonary embolisms was 0.60% (n=15) in the prophylactic group and 0.80% (n=30) in the non-prophylactic group (p=0.090). Of the prophylactic patients, 0.20% (n=4) developed epidural hematomas, while 0.20% (n=9) of the non-prophylactic group developed epidural hematomas (p=0.619). Half of the patients that developed epidural hematomas in each group suffered from neurological deficit due to the complication. The average timing of hematoma was 10.84 days for prophylactic group and 6.2 days for the non-prophylactic group. (Figures 1 & 2).
Conclusions: The risk of spinal epidural hematomas between patients receiving chemoprophylaxis and those who do not is low and not significantly different. This finding highlights that administering anti-coagulant therapy from one day before to three days after surgery is safe for high-risk patients.
Patient Care: The goal of this research is to report on the safety and effectiveness of using anti-coagulant therapy as chemoprophylaxis to prevent pulmonary embolisms after spine surgeries. It is our hope that by reporting the rates of pulmonary embolisms and epidural hematomas after chemoprophylaxis, hospitals and spine surgeons will consider utilizing common risk factors as guidelines when deciding which patients to administer anti-coagulant therapy to prevent pulmonary embolisms and improve quality of patient care.
Learning Objectives: By the conclusion of this session, participants should be able to 1) describe the rate of pulmonary embolisms in patients receiving chemoprophylaxis compared to patients not receiving chemoprophylaxis 2) describe the rate of epidural hematomas in patients receiving chemoprophylaxis compared to patients not receiving chemoprophylaxis 3) identify common risk factors that characterize patients undergoing spine surgeries as higher risk for developing pulmonary embolisms