Oral Posters: Values and Outcomes in Spine Surgery
Presented by: P. Dermarkarian - View Audio/Video Presentation (Members Only)
P. Dermarkarian(1), M. Bender(2), J. Billys(3)
(1) University of South Florida / Florida Orthopaedic Institute, Orthopaedic Surgery, Tampa, FL, United States
(2) University of South Florida, Tampa, FL, United States
(3) Florida Orthopedic Institute, Spine Surgery, Tampa, FL, United States
Background: Despite their relatively low incidence in spine surgery, post-operative venous thromboembolism (VTE) significantly increases post-operative morbidity and mortality while increasing the cost of healthcare delivery via expensive diagnostic testing, prolonged treatment, longer hospital stays, and increased readmission rates. The utilization of VTE prophylaxis, however, is controversial in spine surgery and generally avoided secondary to its theoretically increased risk of postoperative hemorrhage and secondary neurologic deficit. Recent literature has suggested that VTE incidence can be reduced through the implementation of an aggressive VTE prophylaxis protocol though these studies have generally implemented thrice daily (TID) dosing regimens. In this study, we compare our post-operative outcomes in spine surgery patients after initiation of a modified VTE prophylaxis protocol.
Methods: An aggressive post-operative VTE prophylaxis protocol was initiated on all patients in October of 2015 and consisted of administration of 5000 units of subcutaneous heparin twice daily (BID) in conjunction with an 81mg aspirin dose. VTE prophylaxis was initiated no longer than 12 hours post-operatively. A retrospective analysis was then performed to compare the incidence of VTE pre- and post-implementation of this regimen as well as to compare prophylaxis-related complications.
Results: A total of 443 patients underwent spine surgery by one surgeon between January 2015 and March 2016, 185 of which were after the implementation of the prophylactic regimen as described above. Of the 258 patients that were not placed on VTE prophylaxis, 6 patients (2.33%) developed a post-operative deep vein thrombosis (DVT) and 1 patient developed a pulmonary embolism. Conversely, there were no incidents of DVT or PE (p=0.012) after implementation of the protocol. Furthermore, there was no statistically significant difference found in post-operative complications between both cohorts.
Conclusions: In our study, implementation of the above-described VTE prophylaxis regimen significantly reduced the incidence of VTE without increasing the incidence of post-operative complications in comparable patient populations. As such, VTE prophylaxis can safely be implemented to reduce the incidence of post-operative VTE in spine surgery patients and BID-dosing regimens may be an effective alternative to TID dosing.