Practice preference of thromboprophylaxis following spine surgery - an international expert survey of AO spine members

STUDY DESIGN: International survey. OBJECTIVES: Thromboprophylaxis after thoraco-lumbar spine surgery has been a source of controversy for decades. Clear evidence-based guidelines for the best prophylaxis modality are still missing. In this international survey, we asked spine surgeons about their clinical practices. METHODS: A survey was distributed electronically to global members of the AO Spine community. The survey consisted of 27 questions of which 14 were analyzed in this study. Twelve questions addressed general information and two the way in which thromboprophylaxis was performed in patients with or without heightened risk of venous thromboembolism by using LMWH, UFH or other methods. We defined consensus for binary (yes/no) questions at > 80% or < 20%; intermediate consensus between 60 and 80% or 20-40%; an agreement between 40 and 60% was designated controversial. RESULTS: A total of 240 respondents between June 26, 2024 and July 10, 2024 were included. The distribution of regional practice was Asia Pacific (21%), Europe and Southern Africa (33%), Latin America (20%), Middle East and Northern Africa (15%), and North America (11%). The preferred method of thromboprophylaxis was controversial in patients without heightened risk of venous thromboembolism. In contrast, in patients with an increased risk of venous thromboembolism, an intermediate consensus of 75% was found for low molecular weight heparin only. However, pneumatic compression devices were the preferred method in high risk patients in North America. CONCLUSIONS: The way in which thromboprophylaxis is carried out continues to be controversial. There is a need for more studies to build strong guidelines and standardize thromboprophylactic practice.