Thromboprophylaxis in Traumatic and Elective

Analysis of Questionnaire Response and Current Practice of Spine
Trauma Surgeons

Alexander R. Vaccaro et al

SPINE 2010 Volume 35, Number 3, pp 323-329

Generally, questionnaire surveys of what surgeons do are of no more than casual interest. Occasionally a survey of current practice can be informative. There is a great deal of current interest in the role of venous thrombo-embolic prophylaxis and this paper informs the debate. There are useful messages for all Spine Specialists involved in trauma care and elective care regarding current behaviour of Spine Specialists in America. The Spine Trauma study group surveyed 47 experienced American spine surgeons looking to establish current standards of care and observe consensus mainly for trauma.

There were 24 questions in the survey, and three clinical case scenarios pertaining to trauma cases. The American practice may be similar to UK in terms of use of IVC filters which had the highest consensus in the scenarios. The trauma results are interesting as is the timing of initiation of prophylaxis. In the presence of SCI the use of prophylaxis increases.
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In elective cervical surgery , anterior or posterior onl;y around 20 would use chemical prophylaxis . In thoracolumbar elective surgery the figures are much higher at 40% anterior and 51% posterior. Compression stockings and devices are used more often than not. In the cervical spine around 30% would use nothing, in the thoraco lumbar spine 10 would use nothing.

Complications of Pharmacological Prophylaxis.
Of the 47 respondents, 22 (46.8%) had treated spine complications from LMWH prophylaxis.

In addition, 19 (40.4%) respondents had performed an operative intervention
in response to excessive bleeding in patients who had been treated with LMWH prophylaxis.

Six surgeons identified epidural hematomas, and others reported retropharyngeal
hematoma, thrombocytopenia, and wound hematoma. Twelve surgeons (25.5%) observed more wound complications with LMWH prophylaxis.

Nineteen surgeons (40.4%) had experienced postoperative patient mortality due to PE following spine surgery.

No more than mostly mechanical measures were proposed for elective cervical spine surgery.

See the NICE summary