A Survey of Chemoprophylaxis Techniques in Spine Surgery Among American Neurosurgery Training Programs

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World Neurosurg


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.

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ePub ahead of print