Key result
Combined pharmacomechanical prophylaxis shows no VTE benefit over mechanical prophylaxis alone in spine surgery.
Why the study?
Venous thromboembolism is a major morbidity and mortality source after spine surgery, but pharmacological prophylaxis is used selectively due to epidural hematoma risk.
Does Caprini score-guided selective pharmacomechanical prophylaxis compared to mechanical prophylaxis alone alter the risk of venous thromboembolism and bleeding complications in patients undergoing spine instrumentation surgery?
Cohort (n=265)
No
Does Caprini score-guided selective pharmacomechanical prophylaxis compared to mechanical prophylaxis alone alter the risk of venous thromboembolism and bleeding complications in patients undergoing spine instrumentation surgery?
Absolute Event Rate: 1.9% vs 0%
p-value: p=1.00
A structured VTE prophylaxis protocol using universal mechanical prophylaxis and Caprini score-guided selective pharmacomechanical prophylaxis resulted in very low VTE rates and no epidural hematomas following spine instrumentation surgery.
Supports Caprini-guided mechanical prophylaxis with very low VTE risk in spine instrumentation; leaves open whether selective pharmacomechanical addition benefits highest-risk patients.
Background: Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major source of morbidity and mortality in patients undergoing spine surgery.Although various risk factors for developing VTE have been identified, pharmacological prophylaxis is used selectively in spine surgery due to the risk of epidural hematoma.We report our institutional experience with VTE prophylaxis following spine instrumentation surgery across all surgical etiologies.Methods: A single-center retrospective cohort study of patients ≥18 years of age who underwent spine instrumentation surgery for degenerative, traumatic, or oncologic pathologies, and patients of all ages who underwent surgery for spinal deformity over a three-year period was performed.Caprini VTE risk score was used for individual risk stratification.Results: A total of 265 patients were included: degenerative (n=174, 65.7%), trauma (n=45, 17.0%), deformity (n=33, 12.5%), and tumor (n=13, 4.9%).The overall mean age was 46.1±17.5 years, and there were 133 male patients (50.2%).Significant differences existed across groups in age (Kruskal-Wallis H=97.4,p<0.001), index procedure characteristics, and VTE risk profiles.Mechanical prophylaxis alone was employed in 212 patients (80.0%), while 53 patients (20.0%) received combined pharmacomechanical prophylaxis.No patient (0%) in the mechanical-only group developed a perioperative VTE event or postoperative hematoma.One patient (1.9%) in the combined pharmacomechanical group developed a postoperative PE, arising in the context of a preoperative proximal DVT.Firth's penalized logistic regression identified polytrauma (OR 29.0, 95% CI 3.3-3835.0;p=0.001),Caprini score ≥7 (OR 8.8, 95% CI 3.8-20.9;p<0.001), and prior VTE history (OR 61.8, 95% CI 5.7-8406.4;p<0.001) as independent predictors of combined prophylaxis receipt.Conclusion: Mechanical prophylaxis, implemented as part of a structured protocol that included sequential pneumatic compression devices and standardized postoperative care, was associated with low VTE risk following spine instrumentation surgery.Individualized risk stratification using validated tools such as the Caprini score, combined with selective pharmacomechanical prophylaxis in high-risk patients, may optimize outcomes in this population.Prospective multicenter studies are needed to validate these findings.
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Abunimer et al. (2026) conducted a cohort in Spine instrumentation surgery (n=265). Combined pharmacomechanical prophylaxis vs. Mechanical prophylaxis alone was evaluated on Postoperative venous thromboembolism (VTE) (p=1.00). Combined pharmacomechanical prophylaxis in high-risk spine surgery patients resulted in a 1.9% postoperative VTE rate compared to 0% with mechanical prophylaxis alone, with no postoperative epidural hematomas in either group.
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