Investigation of Venous Thromboembolism Prophylaxis Practices in Spinal Fusion Surgery and Outcomes: A Single Center Experience

Yıl 2023, , 528 - 533, 31.05.2023

Ali Akar , Serpil Şahin

https://doi.org/10.16899/jcm.1285262

Öz

Abstract
Aim: Venous thromboembolism (VTE) is among the most common causes of preventable hospital-acquired deaths. VTE is known as deep vein thrombosis (DVT) when it occurs in the veins and pulmonary embolism (PE) when it occurs in the lungs and is common in surgery practice. We aimed to determine the frequency of venous thromboembolism (VTE), the factors affecting the development of VTE, and the types and effectiveness of VTE prophylaxis applications in patients who underwent spinal fusion surgery (SFS).
Material and Methods: The patients aged over 18 who underwent SFS for spinal fracture or thoracolumbar stenosis in our neurosurgery clinic between June, 2020 and December, 2022 were included. The patients records were evaluated retrospectively. VTE prophylaxis was given according to the Caprini risk score.
Results: A total of 137 patients, 85 (62%) of female, with a meanage of 48.6±+8.77 years were included in the study. According to the Caprini risk scores, 90 (65.7%) of the cases were at high risk. VTE was detected in four patients (2.9%) despite prophylaxis (3 cases of DVT and one pulmonary embolism).
Conclusions: Although VTE prophylaxis is performed according to Carpini risk score in SFS, it is seen that embolisms cannot be prevented sufficiently. Therefore, studies with a high level of evidence are needed for the use of these algorithms in SFS.

Anahtar Kelimeler

Caprini score, Prophylaxis, Spinal Fusion Surgery, Venous Thromboembolism

Spinal Füzyon Cerrahisinde Venöz Tromboemboli Profilaksisi Uygulamalarının ve Sonuçlarının İncelenmesi: Tek Merkez Deneyimi

Öz

Öz

Amaç: Venöz tromboembolizm (VTE), önlenebilir hastane kaynaklı ölümlerin en yaygın nedenlerinden biridir. VTE, damarlarda meydana geldiğinde derin ven trombozu (DVT), akciğerlerde meydana geldiğinde pulmoner emboli (PE) olarak bilinir ve cerrahi pratikte sık görülür. Spinal füzyon cerrahisi (SFS) uygulanan hastalarda venöz tromboembolizm (VTE) sıklığını, VTE gelişimini etkileyen faktörleri ve VTE profilaksisi uygulamalarının türlerini ve etkinliğini belirlemeyi amaçladık.

Gereç ve Yöntem: Nöroşirürji kliniğimizde Haziran 2020 ile Aralık 2022 tarihleri arasında omurga kırığı veya torakolomber darlık nedeniyle SFS uygulanan 18 yaş üstü hastalar dahil edildi. Hasta kayıtları retrospektif olarak değerlendirildi. Caprini risk skoruna göre VTE profilaksisi verildi.

Bulgular: Çalışmaya ortalama yaşları 48.6±+8.77 olan 85'i (%62) kadın olmak üzere toplam 137 hasta dahil edildi. Caprini risk skorlarına göre olguların 90'ı (%65,7) yüksek riskli idi. Profilaksiye (3 DVT ve 1 pulmoner emboli) rağmen dört hastada (%2,9) VTE saptandı.

Sonuç: SFS'de VTE profilaksisi Carpini risk skoruna göre yapılmasına rağmen embolilerin yeterince önlenemediği görülmektedir. Bu nedenle bu algoritmaların SFS'de kullanımı için kanıt düzeyi yüksek çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Caprini skoru, Profilaksi, Spinal Füzyon Cerrahisi, Venöz Tromboembolizm

Destekleyen Kurum

yok

Kaynakça

• 1. Kahn SR, Morrison DR, Diendéré G: Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism. Cochrane Database Syst Rev 2018;4:CD008201.
• 2. Tominaga H, Setoguchi T, Tanabe F, et al. Risk factors for venous thromboembolism after spine surgery. Medicine (Baltimore). 2015;94(5):e466.
• 3. Dixon J, Ahn E, Zhou L et al. Venous thromboembolism rates in patients undergoing majör hip and knee joint surgery at WaitemataDistrictHealth Board: a retrospective audit. InternMed J. 2015;45:416-422.
• 4. Zhou X, Qian W, Li J et al. Whoare at risk for thromboembolism after arthroplasty? A systematic review and meta-analysis. Thromb Res. 2013;132(5):531-6.
• 5. Bouyer B, Rudnichi A, Dray-spira R, et al. Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients. J Thromb Haemost. 2018;16(8):1537-1545.
• 6. Piran S, Schulman S. Incidence and risk factors for venous thromboembolism in patients with acute spinal cordinjury: a retrospective study. ThrombRes. 2016;147:97-101.
• 7. Schulte LM, O'Brien JR, Bean MC et al. Deep vein thrombosis and pulmonary embolism after spine surgery: incidence and patient risk factors. Am J Orthop (Belle Mead NJ). 2013;42(6):267-70.
• 8. Schoenfeld AJ, Herzog JP, Dunn JC et al. Patient-based and surgical characteristics associated with the acute development of deep venous thrombosis and pulmonary embolism after spine surgery. Spine (PhilaPa 1976). 2013;38(21):1892-8.
• 9. Cohen AT, Tapson VF, Bergmann J, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387-94.
• 10. Glotzbecker MP, Bono CM, Wood KB et al. Thrombo embolic disease in spinal surgery: a systematic review. Spine (PhilaPa 1976). 2009 Feb 1;34(3):291-303.
• 11. Zhou H, Hu Y, Li X et al. Assessment of the Risk of Venous Thromboembolism in Medical Inpatients using the Padua Prediction Score and Caprini Risk Assessment Model. J AtherosclerThromb. 2018;25(11):1091-1104
• 12. Cronin M, Dengler N, Krauss ES et al. Completion of the Updated Caprini Risk Assessment Model (2013 Version). Clin Appl Thromb Hemost. 2019;25:1076029619838052.
• 13. Pannucci CJ, Bailey SH, Dreszer G et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J AmCollSurg. 2011;212(1):105-12.
• 14. Anderson DR, Morgano GP, Bennett C et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019;3(23):3898-3944.
• 15. Otero R, Uresandi F, Cayuela A et al. Use of venous thromboembolism prophylaxis for surgical patients: a multicentre analysis of practice in Spain. Eur J Surg. 2001;167(3):163-7.
• 16. Scaglione L, Piobbici M, Pagano E et al. Implementing Guidelines for venous thromboembolism prophylaxis in a large Italian teaching hospital: lights and shadows. Haematologica. 2005;90(5):678-84.
• 17. Mosenthal WP, Landy DC, Boyajian HH et al. Thromboprophylaxis in Spinal Surgery. Spine (PhilaPa 1976). 2018;43(8):E474-E481.
• 18. Golemi I, SalazarAdum JP, Tafur A et al. Venous thromboembolism prophylaxis using the Caprini score. DisMon. 2019;65(8):249-298.
• 19. Zhu C, Wang B, Yin J et al. Risk factors for postoperative delirium after spinal surgery: a systematic review and meta-analysis. Aging Clin Exp Res. 2020;32(8):1417-1434.
• 20. Ellenbogen Y, Power RG, Martyniuk A et al. Pharmaco prophylaxis for Venous Thromboembolism in Spinal Surgery: A Systematic Review and Meta-analysis. World Neurosurg. 2021;150:e144-e154.
• 21. Segon YS, Summey RD, Slawski B et al. Surgical venous thromboembolism prophylaxis: clinical practice update. HospPract (1995). 2020;48(5):248-257.
• 22. Weber B, Seal A, McGirr J et al. Case series of elective instrumented posterior lumbar spinal fusions demonstrating a lowincidence of venous thromboembolism. ANZ J Surg. 2016;86(10):796-800.
• 23. Fawi HMT, Saba K, Cunningham A et al. Venous thromboembolism in adult elective spinal surgery: a tertiary centre review of 2181 patients. Bone Joint J. 2017;99-B(9):1204-1209.
• 24. Hayssen H, Cires-Drouet R, Englum B, et al. Systematic review of venous thromboembolism risk categories derived from Caprini score. J Vasc Surg Venous Lymphat Disord. 2022;10(6):1401-1409.e7.
• 25. Bartlett MA, Mauck KF, Stephenson CR et al. Perioperative Venous Thromboembolism Prophylaxis. Mayo ClinProc. 2020;95(12):2775-2798.
• 26. Eskildsen SM, Moll S, Lim MR. An Algorithmic Approach to Venous Thromboembolism Prophylaxis in Spine Surgery. J Spinal Disord Tech. 2015 Oct;28(8):275-81.
• 27. Rockson HB, DiPaola CP, Connolly PJ et al. Venous Thromboembolism Prophylaxis for Patients Having Elective Spine Surgery: When, Why, and How Much. J Bone Joint Surg Am. 2019 Jul 3;101(13):1220-1229.