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

Abstract

To (1) identify risk factors for the development of deep venous thrombosis (DVTs) in patients undergoing spinal irrigation and debridement for an infection with subsequent peripherally inserted central catheter (PICC) placement and to (2) determine if chemoprophylaxis mitigates the risk of developing DVTs. Patients with spinal infection and PICC placement at an academic medical center between 2009-2020 were retrospectively identified. Patients were grouped based on whether they had a 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. Of 335 patients included in the analysis, 48 (14.3%) developed a DVT and 287 (85.7%) did not. Patients who developed a DVT had a greater number of irrigation and debridement 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 [1.01-4.92], p=0.045), DVT/pulmonary embolism (OR=4.49 [1.93-10.34], p<0.001), and the number of irrigation and debridement procedures (OR=1.51 [1.13-2.06], p=0.006) as significant positive predictors of a postoperative DVT. Chemoprophylaxis (OR=0.68 [0.32-1.45], p=0.324) was not a significant negative predictor of postoperative DVT. Patients undergoing spinal debridement with subsequent PICC placement are at high risk for postoperative DVT. Multiple spine debridements, a history of diabetes, and previous DVTs are risk factors for a postoperative DVT. Chemoprophylaxis does not mitigate patients' risk for postoperative DVT.