Use and outcomes of venous thromboembolism prophylaxis after spinal fusion surgery.
Use and outcomes of venous thromboembolism prophylaxis after spinal fusion surgery.
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DOI：
10.1111/j.1538-7836.2011.04326.x
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发表时间：
2011-07
期刊：
影响因子：
--
通讯作者：
Auerbach AD
中科院分区：
文献类型：
--
作者：
Fang MC;Maselli J;Lurie JD;Lindenauer PK;Pekow PS;Auerbach AD
美国脊柱融合手术的数量正在迅速增加，但对脊柱手术后最佳静脉血栓栓塞预防知之甚少。在244家美国医院队列中，研究脊柱融合术后静脉血栓栓塞预防的使用和结局。我们确定了2003 - 2005年在参与Premier Perspective数据库的医院中具有脊柱融合手术主要手术代码的所有患者，并检索了在术后前7天内接受药物预防（皮下注射普通肝素、低分子量肝素或磺达肝素）和/或机械预防（加压装置和弹力袜）的情况。我们还检索了首次住院期间和术后30天内静脉血栓栓塞和术后出血的出院诊断代码。在此期间进行的80，183例脊柱融合手术中，颈椎融合最常见（49.0%），其次是腰椎融合（47.8%）。60.6%的患者在术后第一周内接受了血栓栓塞预防，最常见的形式是单独的机械预防（47.6%）。在244家医院中，26.2%为≥ 90%接受脊柱融合术的患者提供了预防;然而，33.2%为少于50%的患者提供了预防。术后30天内诊断为静脉血栓栓塞的发生率为0.45%，术后出血的发生率为1.1%。在美国，脊柱融合术后血栓栓塞预防的使用存在很大差异。尽管如此，脊柱融合术后诊断血栓栓塞的总体发生率似乎较低。
The number of spinal fusion surgeries in the US is rapidly rising but little is known about optimal venous thromboembolism prophylaxis after spinal surgery. To examine the use and outcomes associated with venous thromboembolism prophylaxis after spinal fusion surgery in a cohort of 244 US hospitals. We identified all patients with a principal procedure code for spinal fusion surgery in hospitals participating in the Premier Perspective database from years 2003 – 2005 and searched for receipt of pharmacologic prophylaxis (subcutaneous unfractionated heparin, low molecular weight heparin, or fondaparinux) and/or mechanical prophylaxis (compression devices and elastic stockings) within the first 7 days after surgery. We also searched for discharge diagnosis codes for venous thromboembolism and post-operative hemorrhage during the index hospitalization and within 30 days after surgery. Among 80,183 spinal fusion surgeries performed during the time period, cervical fusions were the most common (49.0%) followed by lumbar fusions (47.8%). Thromboembolism prophylaxis was administered to 60.6% of patients within the first week post-operatively, with the most frequent form being mechanical prophylaxis alone (47.6%). Of the 244 hospitals, 26.2% provided prophylaxis to ≥ 90% of their patients undergoing spinal fusion; however, 33.2% provided prophylaxis to fewer than 50% of their patients. The rate of diagnosed venous thromboembolism within 30 days after surgery was 0.45% and the rate of postoperative hemorrhage was 1.1%. Substantial variation exists in the use of thromboembolism prophylaxis after spinal fusion surgery in the US. Nevertheless, overall rates of diagnosed thromboembolism after spinal fusion appear low.
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