Incidencia y factores de riesgo de enfermedad tromboembólica venosa en cirugía mayor espinal, sin profilaxis química o mecánica / Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis

Objetivos. Evaluar la incidencia de enfermedad tromboembólica venosa sin profilaxis química o mecánica y valorar factores de riesgo específicos. Material y métodos. Realizamos un estudio de cohorte histórica en pacientes sometidos a cirugía espinal mayor, entre enero de 2010 y septiembre de 2014, con un total de 1.092 casos. En ningún paciente se administró tromboprofilaxis perioperatoria química o mecánica, indicando la movilización activa de los miembros inferiores y la deambulación precoz en torno a las primeras 24-48 h. Los casos clínicamente sintomáticos se confirmaron con eco-doppler de miembros inferiores o angio-TC de tórax. Resultados. Se identificaron 3 casos (0,27%) con TVP y 3 casos (0,27%) con TEP, con un caso letal (0,09%). En total, los eventos relacionados a ETV ascendieron a 0,54% (n = 5). No hubo casos de complicaciones de sangrado mayor o hematoma epidural. Se identificaron los siguientes factores de riesgo: cirugías de 4 o más niveles, intervenciones más largas de 130 min, más de 70 años de edad, el padecimiento de HTA y el diagnóstico de escoliosis degenerativa. Discusión. En cirugía espinal, actualmente existe poca evidencia científica que determine la influencia de los distintos factores de riesgo tromboembólicos y la prevención de los mismos, sumado a la disparidad de los métodos profilácticos indicados por los distintos especialistas, teniendo que sopesar el riesgo de sangrado perioperatorio, incluso la aparición de hematoma epidural. La indicación de profilaxis farmacológica debe valorarse en pacientes mayores de 70 años con HTA, cirugía prolongada más de 130 min o de 4 o más niveles (AU)

Objectives. To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication. Materials and methods. A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24-48 hours after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography. Results. A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 minutes, patients older than 70 years of age, hypertension, and degenerative scoliosis. Discussion. There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 minutes, when 4 or more levels are involved (AU)

[Incidence and risk factors of venous thromboembolism in major spinal surgery with no chemical or mechanical prophylaxis]. / Incidencia y factores de riesgo de enfermedad tromboembólica venosa en cirugía mayor espinal, sin profilaxis química o mecánica.

OBJECTIVES: To evaluate the incidence of venous thromboembolism in spine surgery with no chemical and mechanical prophylaxis, and to determine the specific risk factors for this complication. MATERIALS AND METHODS: A historical cohort was analysed. All patients subjected to major spinal surgery, between January 2010 and September 2014, were included. No chemical or mechanical prophylaxis was administered in any patient. Active mobilisation of lower limbs was indicated immediately after surgery, and early ambulation started in the first 24-48 hours after surgery. Clinically symptomatic cases were confirmed by Doppler ultrasound of the lower limbs or chest CT angiography. RESULTS: A sample of 1092 cases was studied. Thromboembolic events were observed in 6 cases (.54%); 3 cases (.27%) with deep venous thrombosis and 3 cases (.27%) with pulmonary thromboembolism. A lethal case was identified (.09%). There were no cases of major bleeding or epidural haematoma. The following risk factors were identified: a multilevel fusion at more than 4 levels, surgeries longer than 130 minutes, patients older than 70 years of age, hypertension, and degenerative scoliosis. DISCUSSION: There is little scientific evidence on the prevention of thromboembolic events in spinal surgery. In addition to the disparity of prophylactic methods indicated by different specialists, it is important to weigh the risk-benefit of intra- and post-operative bleeding, and even the appearance of an epidural haematoma. Prophylaxis should be assessed in elderly patients over 70 years old, who are subjected to surgeries longer than 130 minutes, when 4 or more levels are involved.

Acetylcholinesterase inhibitors and healing of hip fracture in Alzheimer's disease patients: a retrospective cohort study.

OBJECTIVES: This study was designed to assess effects of cholinergic stimulation using acetylcholinesterase inhibitors (AChEIs), a group of drugs that stimulate cholinergic receptors and are used to treat Alzheimer's disease (AD), on healing of hip fractures. METHODS: A retrospective cohort study was performed using 46-female AD patients, aged above 75 years, who sustained hip fractures. Study analyses included the first 6-months after hip fracture fixation procedure. Presence of AChEIs was used as predictor variable. Other variables that could affect study outcomes: age, body mass index (BMI), mental state or type of hip fracture, were also included. Radiographic union at fracture site (Hammer index), bone quality (Singh index) and fracture healing complications were recorded as study outcomes. The collected data was analyzed by student's-t, Mann-Whitney-U and chi-square tests. RESULTS: No significant differences in age, BMI, mental state or type of hip fracture were observed between AChEIs-users and nonusers. However, AChEIs-users had better radiographic union at the fracture site (relative risk (RR),2.7; 95%confidence interval (CI),0.9-7.8), better bone quality (RR,2.0; 95%CI,1.2-3.3) and fewer healing complications (RR,0.8; 95%CI,0.7-1.0) than nonusers. CONCLUSION: In elderly female patients with AD, the use of AChEIs might be associated with an enhanced fracture healing and minimized complications.