title: [Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis].
abstract: OBJECTIVE
  To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication.
  
  
  METHODS
  A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24-48 hours after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography.
  
  
  RESULTS
  A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 minutes, patients older than 70 years of age, hypertension, and degenerative scoliosis.
  
  
  CONCLUSIONS
  There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 minutes, when 4 or more levels are involved.
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España. Electronic address: frojascot@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Rojas-Tomba
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: I
authors.initials: I
authors.lastname: Gormaz-Talavera
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: I E
authors.initials: IE
authors.lastname: Menéndez-Quintanilla
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: J
authors.initials: J
authors.lastname: Moriel-Durán
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: D
authors.initials: D
authors.lastname: García de Quevedo-Puerta
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
authors.forename: F
authors.initials: F
authors.lastname: Villanueva-Pareja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004434:Early Ambulation; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult
keywords: Cirugía espinal; Deep venous thrombosis; Profilaxis; Prophylaxis; Pulmonary thromboembolism; Spine surgery; Tromboembolismo pulmonar; Tromboembolismo venoso; Trombosis venosa profunda; Venous thromboembolism