Is Deep Vein Thrombosis Chemoprophylaxis Indicated After Spinal Irrigation and Débridement?

Abstract

Objective: To identify risk factors for development of deep venous thrombosis (DVT) in patients undergoing spinal irrigation and débridement for an infection with subsequent peripherally inserted central catheter placement and to determine if chemoprophylaxis mitigates the risk of developing DVT.

Methods: Patients with spinal infection and peripherally inserted central catheter placement at an academic medical center between 2009 and 2020 were retrospectively identified. Patients were grouped based on whether they had postoperative DVT. Preoperative, intraoperative, and postoperative variables were compared to determine their association with postoperative DVT. A multivariate logistic regression model was developed to measure the effect of postoperative DVT chemoprophylaxis on the likelihood of DVT development.

Results: Of 335 patients included in the analysis, 48 (14.3%) developed DVT, and 287 (85.7%) did not develop DVT. Patients who developed DVT had a greater number of irrigation and débridement procedures (1.90 ± 1.49 vs. 1.44 ± 0.86, P = 0.024). Multivariate logistic regression analysis identified a history of diabetes (odds ratio [OR] = 2.23; 95% confidence interval [CI], 1.01-4.92; P = 0.045), DVT/pulmonary embolism (OR = 4.49; 95% CI, 1.93-10.34; P < 0.001), and number of irrigation and débridement procedures (OR = 1.51; 95% CI, 1.13-2.06; P = 0.006) as significant positive predictors of postoperative DVT. Chemoprophylaxis (OR = 0.68; 95% CI, 0.32-1.45; P = 0.324) was not a significant negative predictor of postoperative DVT.

Conclusions: Patients undergoing spinal débridement with subsequent peripherally inserted central catheter placement are at high risk for postoperative DVT. Multiple spine débridement procedures, a history of diabetes, and previous DVT are risk factors for postoperative DVT. Chemoprophylaxis does not mitigate patients' risk for postoperative DVT.

Keywords: Cervical spine; Chemoprophylaxis; Deep venous thrombosis; Infection; Irrigation and débridement; Lumbar spine; Pulmonary embolism.