Sunday, October 3, 2010
18199

The Incidence of Venous Thromboembolism in Post-Operative Plastic and Reconstructive Surgery Patients with Chronic Spinal Cord Injury

Jonathan C. Rimler, MD, Surgery- Division of Plastic Surgery, UC-Irvine Medical Center, 200 S. Manchester Ave, Suite 650, Orange, CA 92868, Amir Shbeeb, BS, School of Medicine, UC-Irvine, Berk Hall, Building 802, Irvine, CA 92697, Walter Chua, MD, Surgery, VA Medical Center, Long Beach California, 5901 East 7th Street, Long Beach, CA 90822, Garrett A. Wirth, MD, Plastic Surgery, UC Irvine, Suite 650, 200 South Manchester, Orange, CA 92868-3298, and Keyianoosh Z. Paydar, MD, Surgery- Division of Plastic Surgery, University of California, Irvine, 200 S. Manchester Ave, Suite 650, Orange, CA 92868.

Purpose: To determine the incidence of post-operative venous thromboembolism (VTE) in chronic spinal cord injury patients undergoing plastic and reconstructive surgery operations.

Materials and Methods: A retrospective data analysis was undertaken using data from a single center experience from January 2004 through November 2009 in which the peri-operative course of chronic spinal cord injury patients was evaluated for evolution of VTE. This retrospective chart review was completed using an electronic medical record system.

Experience and Results: Of the 415 operative courses evaluated, 155 cases were excluded secondary to: operative time less than one hour, use of sequential compression devices (SCD), chemoprophylaxis w/ Lovenox or heparin, unknown operative time, or unknown SCD use. Of the remaining 260 cases evaluated with no mechanical or chemical VTE prophylaxis, there were no deep venous thromboses (DVT) or pulmonary emboli (PE) diagnosed in a 2month post-operative time period, and this included 8 patients with a history of prior DVT or PE. The average time since spinal cord injury in this cohort of patients was 26.2 years, the average procedure length was 141.42 minutes, the average age was 59, and the average BMI was 24.8. In 236 of the cases, the patient was an American Society of Anesthesiologists (ASA) classification system grade 3, and in 14 cases the patient was a class 4.

Conclusion: Post operative venous thromboembolism is a common surgical complication that often results in significant morbidity and mortality. While basic science research has yet to fully elucidate the mechanism by which chronic spinal cord injury patients are protected against the formation of deep venous thrombosis, this data shows that in the chronic spinal cord injury patient cohort, the incidence of post-operative deep venous thrombosis or pulmonary embolus is extremely low and that these patients likely do not require peri-operative mechanical or chemical prophylaxis. This decreases the risk of post-operative bleeding, hematoma, or even compromise of the fresh muscular, musculocutaneous, or musculofasciocutaneous flaps commonly employed in this patient cohort. Foregoing VTE prophylaxis throughout the hospital stay of this patient cohort will also result in substantial cost savings to the health care system over time and improve patient safety.

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