title: The incidence of venous thromboembolism in postoperative plastic and reconstructive surgery patients with chronic spinal cord injury.
abstract: BACKGROUND
  The purpose of this study was to investigate the incidence of postoperative venous thromboembolism in chronic spinal cord injury patients undergoing plastic and reconstructive surgery. Previous studies show a venous thromboembolism incidence of 9.3 percent; however, based on anecdotal evidence, the authors hypothesize that the incidence is actually much lower. As postoperative venous thromboembolism prophylaxis is becoming mandated by the Surgical Care Improvement Project, more data are necessary so that recommendations for chronic spinal cord injury patients can be given.
  
  
  METHODS
  A retrospective chart review was undertaken using electronic medical records from a Veterans Affairs hospital from 2004 through 2009 in which the perioperative course of the chronic spinal cord injury cohort was evaluated for the primary endpoint of venous thromboembolism evolution. The Pearson correlation was used for statistical analysis.
  
  
  RESULTS
  Of the 415 operative cases evaluated, 155 cases were excluded secondary to operative time under 1 hour, use of mechanical or chemical venous thromboembolism prophylaxis, unknown operative time, or unknown prophylaxis use. Of the 260 cases evaluated without venous thromboembolism prophylaxis, there were no cases where venous thromboembolism developed within a 2-month postoperative time period.
  
  
  CONCLUSIONS
  Postoperative venous thromboembolism is a common surgical complication with significant morbidity and mortality. This study demonstrates that in the chronic spinal cord injury patient cohort, the incidence of postoperative venous thromboembolism evolution is extremely low and that a benefit from perioperative mechanical or chemical prophylaxis is not evidence based. Further prospective studies are required to fully elucidate the true venous thromboembolism incidence in these patients and give recommendations on this issue.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Orange and Long Beach, Calif. From the Aesthetic and Plastic Surgery Institute, University of California Irvine Medical Center, and the Veterans Affairs Long Beach Health System.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Rimler
authors.forename: Thomas
authors.initials: T
authors.lastname: Scholz
authors.forename: Amir
authors.initials: A
authors.lastname: Shbeeb
authors.forename: Walter
authors.initials: W
authors.lastname: Chua
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Wirth
authors.forename: Keyianoosh Z
authors.initials: KZ
authors.lastname: Paydar
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003646:Debridement; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D003668:Pressure Ulcer / Q000453:epidemiology / Q000601:surgery; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000601:surgery*; D013524:Surgical Flaps; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control