Timing and risks of chemoprophylaxis after spinal surgery: A single-center experience with 6869 consecutive patients

Ekamjeet S. Dhillon, Ryan Khanna, Michael Cloney, Helena Roberts, George R. Cybulski, Tyler R. Koski, Zachary A. Smith, Nader S. Dahdaleh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

OBJECTIVE: Venous thromboembolism (VTE) after spinal surgery is a major cause of morbidity, but chemoprophylactic anticoagulation can prevent it. However, there is variability in the timing and use of chemoprophylactic anticoagulation after spine surgery, particularly given surgeons' concerns for spinal epidural hematomas. The goal of this study was to provide insight into the safety, efficacy, and timing of anticoagulation therapy after spinal surgery. METHODS: The authors retrospectively examined records from 6869 consecutive spinal surgeries performed in their departments at Northwestern University. Data on patient demographics, surgery, hospital course, timing of chemoprophylaxis, and complications, including deep venous thrombosis (DVT), pulmonary embolism (PE), and spinal epidural hematomas requiring evacuation, were collected. Data from the patients who received chemoprophylaxis (n = 1904) were compared with those of patients who did not (n = 4965). The timing of chemoprophylaxis, the rate of VTEs, and the incidence of spinal epidural hematomas were analyzed. R ESULTS: The chemoprophylaxis group had more risk factors, including greater age (59.70 vs 51.86 years, respectively; p < 0.001), longer surgery (278.59 vs 145.66 minutes, respectively; p <0.001), higher estimated blood loss (995 vs 448 ml, respectively; p <0.001), more comorbid diagnoses (2.69 vs 1.89, respectively; p <0.001), history of VTE (5.8% vs 2.1%, respectively; p <0.001), and a higher number were undergoing fusion surgery (46.1% vs 24.7%, respectively; p <0.001). The prevalence of VTE was higher in the chemoprophylaxis group (3.62% vs 2.03%, respectively; p <0.001). The median time to VTE occurrence was shorter in the nonchemoprophylaxis group (3.6 vs 6.8 days, respectively; p = 0.0003, log-rank test; hazard ratio 0.685 [0.505-0.926]), and the peak prevalence of VTE occurred in the first 3 postoperative days in the nonchemoprophylaxis group. The average time of initiation of chemoprophylaxis was 1.46 days after surgery. The rates of epidural hematoma were 0.20% (n = 4) in the chemoprophylaxis group and 0.18% (n = 9) in the nonchemoprophylaxis group (p = 0.622). CONCLUSIONS: The risks of spinal epidural hematoma among patients who receive chemoprophylaxis and those who do not are low and equivalent. Administering anticoagulation therapy from 1 day before to 3 days after surgery is safe for patients at high risk for VTE.

Original languageEnglish (US)
Pages (from-to)681-693
Number of pages13
JournalJournal of Neurosurgery: Spine
Volume27
Issue number6
DOIs
StatePublished - Dec 2017

Keywords

  • Chemoprophylaxis
  • Epidural hematoma
  • Heparin
  • Infection
  • LMWH
  • Venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Timing and risks of chemoprophylaxis after spinal surgery: A single-center experience with 6869 consecutive patients'. Together they form a unique fingerprint.

Cite this