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Thromboprophylaxis in Traumatic and Elective Spinal Surgery: Analysis of Questionnaire Response and Current Practice of Spine Trauma Surgeons

Ploumis, Avraam MD, PhD; Ponnappan, Ravi K. MD; Sarbello, John BS; Dvorak, Marcel MD; Fehlings, Michael G. MD; Baron, Eli MD; Anand, Neel MD; Okonkwo, David O. MD; Patel, Alpesh MD; Vaccaro, Alexander R. MD, PhD

doi: 10.1097/BRS.0b013e3181ca652e
Health Services Research

Study Design. A survey on thromboprophylaxis in spinal surgery and trauma was conducted among spine trauma surgeons.

Objective. Neurosurgeons and orthopedic surgeons from the Spinal Trauma Study Group were surveyed in an attempt to understand current practices in the perioperative administration of thromboprophylaxis in spinal surgery.

Summary of Background Data. Although much research has been invested in the prevention of thromboembolic events following surgical procedures, there have been few investigations specific to spinal surgery, especially in the context of trauma.

Methods. A total of 47 spine surgeons were provided with a 24-question survey pertaining to deep vein thrombosis prophylaxis in spine surgical patients. There was 100% response to the survey, and 46 of the 47 physicians (98%) responded to the case scenarios.

Results. Institutional protocols for deep vein thrombosis prophylaxis existed for 42 (89%) of the respondents; however, only 27 (57%) indicated that these protocols included spinal cord injury (SCI) patients. Before surgery, no prophylaxis or mechanical prophylactic measures for SCI and non-SCI spinal fracture patients were routinely used by 36 (77%) and 40 (85%) respondents, respectively. After surgery, pharmacologic prophylaxis was prescribed by 42 (91%) and 28 (62%) surgeons for SCI and non-SCI spinal fracture patients, respectively. There was a statistically significant tendency to use more intensive prophylactic measures for patients with SCI (x2, 10.86; P < 0.01) as well as a statistically significant longer duration of proposed thromboprophylaxis (x 2, 24.62; P < 0.001). Postoperative pharmacologic thromboprophylaxis for elective anterior thoracolumbar spine surgery was reported by 23 (51%) of the respondents, whereas only 18 (40%) used pharmacological prophylaxis in elective posterior thoracolumbar spine cases. Spine complications from low-molecular weight heparin were reported by 22 (47%) surgeons, including fatal pulmonary embolism by 19 (40%) surgeons.

Conclusion. A basis for a consensus protocol on thromboprophylaxis in spinal trauma was attempted. No more than mechanical prophylaxis was recommended before surgery for non-SCI patients or after surgery for elective cervical spine cases. Chemical prophylaxis was commonly used after surgery in patients with SCI and in patients with elective anterior thoracolumbar surgery.

A survey on thromboprophylaxis in spinal surgery and trauma was conducted among surgeons of Spinal Trauma Study Group. The recommended mode (none, mechanical, chemical), time of initiation, duration, and possible complications of thromboprophylaxis were analyzed, and followed by consensus-based recommendations. Spinal trauma with spinal cord injury affecting mobility generally necessitated chemical prophylaxis for at least 6 weeks. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Department of Orthopaedics, Jefferson University, Philadelphia, PA.

Acknowledgment date: October 21, 2008. Revision date: April 21, 2009. Acceptance date: May 19, 2009.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Avraam Ploumis, MD, PhD, Rothman Institute, 925 Chestnut St., Philadelphia, PA 19107; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.