Thromboembolic Prophylaxis Practices Vary by Surgeon

Spinal surgeons' decisions often based on personal experience, not scientific evidence

MONDAY, Dec. 22 (HealthDay News) -- Spinal surgeons vary widely in their practices for thromboembolic prophylaxis after high-risk surgery and often base their decisions on personal experience over scientific evidence, according to the results of a study published in the Dec. 15 issue of Spine.

Michael P. Glotzbecker, M.D., from Harvard Medical School in Boston, and colleagues surveyed 94 orthopaedic and neurosurgical spine surgeons regarding their current practices of thromboembolic prophylaxis after high-risk surgery for tumors and trauma.

The researchers found that the responses were widely variable regarding a safe time point to start chemoprophylaxis, their agent of choice for prophylaxis, the risk of clinically relevant postoperative epidural hematoma, the perceived risk for deep venous thrombosis, and the decision to use an inferior vena cava filter. Most (63 percent) said that they based their decisions on personal experience rather than scientific evidence.

"These data are the first to demonstrate the wide variability of surgeons' practices regarding thromboembolic prophylaxis in high-risk spine surgery patients," Glotzbecker and colleagues conclude. "This study highlights the need for more rigorous prospective evaluation of thromboembolic risk after spinal surgery and, subsequently, the efficacy and safety of currently available thromboembolic prophylaxis protocols."

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