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Resident PGY 4
Henry Ford Hospital
The North American Spine Section (NASS) published the Evidence-Based Clinical Guide for the use of antithrombotics in spine surgery. Many of the 14 clinical questions lacked clinical studies to establish evidence-based recommendations, as such expert consensuses were arrived at via a modified nominal group technique. On the clinical inquiry of chemoprophylaxis, the study published that “Unfortunately, scientific scrutiny of chemoprophylaxis in elective spinal surgery has been limited to case series involving discectomy and decompression…safety and efficacy have not been thoroughly studied." This knowledge gap in the optimal prevention of VTE events may be approximated with higher levels of evidence in spine surgery research, which should begin in first understanding chemoprophylaxis techniques across a wide geographical array of neurosurgical training programs. Of the 107 ACGME-approved residencies, contact information for 96 programs were available from ACGME, and responses from 69 unique neurosurgery residencies were collected. Thus, this survey study achieved a 64% respondent rate. Responses appeared equally distributed across the country. The first dose of chemoprophylaxis among patients undergoing surgery for degenerative/ deformity spinal disease started most commonly on postoperative day 1 in 75.3% of neurosurgery programs (n = 52) followed by postoperative day 2 in 10.1% of programs (n = 7), postoperative day 0 – same day of surgery in 8.7% of programs (n = 6), postoperative day 3 in 1.4% of programs (n = 1), and morning of surgery in 1.4% of programs (n = 1). Lastly, 2.9% of programs (n = 2) do not utilize any chemoprophylaxis. Among two of the three indications for spinal surgery, choice of postoperative chemoprophylaxis did not statistically significantly differ between prophylactic UFH versus prophylactic LMWH: 56.5% versus 50.7% in degenerative/ deformity pathologies (p=0.080) and 36.2% versus 43.4% in traumatic pathologies (p-0.535). However, neoplastic pathologies saw a statistically significantly higher proportion of prophylactic UFH (60.8%) compared to prophylactic LMWH (36.2%) (p=0.037). Of those neurosurgeons who documented “other”, one explained that the choice of chemoprophylaxis depends on comorbidities. Similarly, the other mentioned creatinine clearance and “risk factors” as determinants.
Macki, Mohamed; Anand, Sharath Kumar; Fakih, Mohamed; Elmenini, Jaafar; and Chang, Victor, "A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs" (2019). Quality Improvement. 17.