title: Prevalence and countermeasures for venous thromboembolic diseases associated with spinal surgery: a follow-up study of an institutional protocol in 209 patients.
abstract: METHODS
  A prospective study of 209 patients undergoing spinal surgery.
  
  
  OBJECTIVE
  To determine the incidence of venous thromboembolic diseases, including deep venous thrombosis (DVT) and pulmonary embolism (PE), and to evaluate the effectiveness of an institutional protocol for venous thromboembolic diseases during the spinal surgery perioperative period.
  
  
  BACKGROUND
  Although patients undergoing spinal surgery are at risk of venous thromboembolism (VTE), there are no universally accepted guidelines for VTE prophylaxis.
  
  
  METHODS
  Between December 2006 and January 2011, 209 patients undergoing spinal surgery (121 males, 88 females; average age: 64 yr), who also had ultrasonographic assessments of both legs before and after surgery, were prospectively assessed. A pneumatic sequential compression device and standard compression stockings were used for primary VTE prophylaxis. In Mie University Hospital protocol, pharmacological agents were not used for VTE prophylaxis after surgery. However, when a distal type DVT was found preoperatively, an anticoagulant medication was administered until 6 hours prior to surgery. After detection of DVTs, weekly ultrasonography assessed the DVT.
  
  
  RESULTS
  Twenty-three patients (11.0%) showed VTE in the spinal surgery perioperative period. Nine patients (4.3%) had VTE (PE with proximal DVT, 1 [0.5%]; distal DVT, 8 [3.8%]) before surgery. In the one case of asymptomatic PE with proximal DVT, an inferior vena cava filter was placed before surgery. Fourteen patients (6.7%) developed new-onset VTE (PE with proximal DVT, 2 [1.0%]; distal DVT, 12 [5.9%]) after spinal surgery. New-onset PE with proximal DVT occurred in 2 patients after surgery. Follow-up ultrasonographic assessment showed that the DVT disappeared completely in 85% (17/20) of patients with a distal type DVT during the perioperative period.
  
  
  CONCLUSIONS
  DVT assessment using ultrasonography is important for proper management of VTE during the perioperative period of spinal surgery, especially for high-risk patients, such as those with advanced age or neurological deficit. The institutional protocol for VTE using pneumatic sequential compression device and compression stockings is effective, although the administration of chemoprophylaxis should be considered for high-risk patients, such as those with spinal tumors and spinal trauma.
authors.affiliation: From the Departments of *Orthopaedic Surgery and †Spine Surgery and Medical Engineering, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Akeda
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Matsunaga
authors.forename: Takao
authors.initials: T
authors.lastname: Imanishi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sakakibara
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kasai
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sudo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D015995:Prevalence; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013131:Spine / Q000601:surgery*; D053828:Stockings, Compression; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control