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Safety of Thromboembolic Chemoprophylaxis in Spinal Trauma Patients Requiring Surgical Stabilization

Jacobs, Lloydine J. MD; Woods, Barrett I. MD; Chen, Antonia F. MD, MBA; Lunardini, David J. MD; Hohl, Justin B. MD; Lee, Joon Y. MD

doi: 10.1097/BRS.0b013e31829879cc
Surgery

Study Design. Retrospective review.

Objective. To determine the incidence of thromboembolic events, bleeding complications such as epidural hematomas, and wound complications in patients with spinal trauma requiring surgical stabilization.

Summary of Background Data. Literature addressing the safety and efficacy of chemoprophylactic agents in postoperative patients with spinal trauma is sparse. As a result, significant variability exists regarding administration of thromboembolic chemoprophylaxis in this population. The risk of bleeding complications is particularly concerning.

Methods. Patients with spinal trauma who underwent surgical stabilization in 2009 and 2010 at a single level 1 trauma center were retrospectively reviewed. Exclusion criteria included patients who underwent solely decompressive procedures, noninstrumented fusions, kyphoplasty, or had incomplete medical records. Patients who received chemoprophylaxis were compared with patients who did not. Demographical information and injury data were collected. Primary outcome measures were prevalence of thromboembolic events, epidural hematomas, and persistent wound drainage requiring irrigation and debridement.

Results. Two hundred twenty-seven of 373 patients were included (56 in the untreated group, 171 in the treated group). Eight patients in the untreated group (14.3%) and 12 patients in the treated group (7%) developed postoperative thromboembolism (P = 0.096). There was 1 pulmonary embolism in the untreated group (1.8%), and 4 pulmonary embolisms in the treated group (2.3%). Surgical irrigation and debridement for wound drainage was required for 1.8% of patients in the untreated group and for 5.3% of patients in the treated group. No epidural hematomas were noted in either group. The treated group had more spinal levels fused (P = 0.46), higher injury severity scores (0.001), and longer hospitalizations (0.018). Patients who developed postoperative thromboembolism had significantly higher body mass indexes (P = 0.01), injury severity scores (0.001), number of spinal levels fused (P = 0.004), incidence of neurological deficits (0.001), and longer hospitalizations (0.16) compared with those who did not.

Conclusion. The use of chemoprophylaxis appears to be safe in at-risk patients in the immediate postoperative period after spinal trauma surgery. No epidural hematomas occurred, and the risk of wound drainage is small. Body mass index, injury severity score, presence of neurological deficits, and number of spinal levels fused should be considered when determining which patients should receive chemoprophylaxis after surgical stabilization.

Level of Evidence: 3

In this study, the use of chemoprophylaxis seemed to be safe in patients with spinal trauma at risk for postoperative venous thromboembolic event (VTE). There were no epidural hematomas recorded in this study. BMI, injury severity, neurological deficit, and number of spinal levels fused were all associated with an increased incidence of postoperative VTE.

From the University of Pittsburgh Medical Center, Department of Orthopaedic Surgery, Pittsburgh, PA.

Address correspondence and reprint requests to Lloydine J. Jacobs, MD, University of Pittsburgh Medical Center, Department of Orthopaedic Surgery Kaufmann Medical Building, Ste 911, 3471 Fifth Ave, Pittsburgh, PA 15213; E-mail: Jacobslj@upmc.edu

Acknowledgment date: October 22, 2012. First revision date: February 24, 2013. Second revision date: April 3, 2013. Third revision date: April 21, 2013. Acceptance date: April 23, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins