Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis

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• 作者：F. Rojas-Tomba ; ^{frojascot@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{facurojas@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; I. Gormaz-Talavera ; I.E. Mené ; ndez-Quintanilla ; J. Moriel-Durá ; n ; D. Garc&iacute ; a de Quevedo-Puerta ; F. Villanueva-Pareja
• 关键词：Spine surgery ; Venous thromboembolism ; Deep venous thrombosis ; Pulmonary thromboembolism ; Prophylaxis
• 刊名：Revista Española de Cirugía Ortopédica y Traumatología
• 出版年：2016
• 出版时间：March-April 2016
• 年：2016
• 卷：60
• 期：2
• 页码：133-140
• 全文大小：515 K

文摘

To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication.

id="absSec_2">Materials and methods

id="spar0010">A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24–48 h after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography.

id="absSec_3">Results

id="spar0015">A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 min, patients older than 70 years of age, hypertension, and degenerative scoliosis.

id="absSec_4">Discussion

id="spar0020">There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 min, when 4 or more levels are involved.