A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs
Recommended Citation
Macki M, Haider SA, Dakroub B, Anand SK, Fakih M, Elmenini J, Suryadevara R, and Chang V. A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs. World Neurosurg 2019.
Document Type
Article
Publication Date
9-13-2019
Publication Title
World Neurosurg
Abstract
BACKGROUND: A paucity of randomized trials have compared prophylactic dose of unfractionated heparin (UFH) versus low-molecular-weight heparin (LMWH) for the prevention of venous thromboembolic events in spinal surgery. Our objective: to determine the most prevalent chemoprophylactic techniques in spine surgery.
METHODS: The AGME was queried for all neurosurgical residency programs, which were subsequently sent an electronic survey about prophylactic UFH vs LMWH in spine surgery for 1) degenerative/deformity, 2) traumatic, and 3) neoplastic pathologies RESULTS: Of 69 unique responding residencies, the first dose of chemoprophylaxis for degenerative/deformity spinal disease started most commonly on postoperative day (POD) 1 in 75.3% of neurosurgery programs followed by POD 2 in 10.1% of programs, POD 0 - same day of surgery in 8.7% of programs, POD 3 in 1.4% of programs, and morning of surgery in 1.4% of programs. Choice of postoperative chemoprophylaxis did not statistically significantly differ between UFH versus LMWH: 56.5% versus 36.2% in degenerative/ deformity pathologies (P=0.080) and 50.7% versus 43.4% in traumatic pathologies (P =0.535). Three programs (4.3%) in both the degenerative/deformity and trauma groups documented no chemoprophylaxis. Neoplastic pathologies saw a statistically significantly higher proportion of prophylactic UFH (60.8%) compared to prophylactic LMWH (36.2%) (P =0.037). One program (1.4%) in the neoplastic group did not utilize chemoprophylaxis. Two institutions (2.8%) in the degenerative/deformity cohort and one institution (1.4%) in the trauma and cancer cohorts reported "other."
CONCLUSION: Prophylactic UFH was statistically more common than LMWH in neoplastic spinal surgery, but not in the degenerative/deformity and trauma groups (cohorts). Further trials are warranted.
PubMed ID
31525483
ePublication
ePub ahead of print
