Combination of Intermittent Pneumatic Compression and Graduated Compression Stockings for the Prevention of Deep Venous Thrombosis in Separation Surgery for Thoracolumbar Metastases: Mandatory or Optional?

Abstract

Retrospective single-institution cohort study. To evaluate the efficacy of combined intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) versus GCS alone for preventing deep venous thrombosis (DVT) in patients undergoing separation surgery for thoracolumbar metastases. DVT is a significant perioperative complication in spinal metastasis surgery. Mechanical prophylaxis is preferred over chemoprophylaxis due to bleeding risks, but evidence supporting the combined use of IPC and GCS over GCS alone is lacking. From 2018 to 2023, 385 patients undergoing separation surgery were included. Group A (n=184) received GCS alone; Group B (n=201) received combined IPC and GCS. All patients underwent compression duplex ultrasound preoperatively and on postoperative day 7 to detect DVT. Demographic, surgical, and neurological data were collected and compared. Overall DVT incidence was 7.6% in Group A and 6.5% in Group B, with no significant difference (P>0.05). No symptomatic pulmonary embolism occurred. Subgroup analysis of patients with preoperative Frankel A-C scores (severe neurological impairment) showed a significantly lower DVT rate in the combined therapy group (4.8% vs. 8.6%, P<0.05). No difference was found in patients with Frankel D-E scores. Combined IPC and GCS significantly reduced DVT incidence in patients with severe preoperative neurological impairment (Frankel A-C) but not in those with milder deficits (Frankel D-E). Preoperative neurological status should guide DVT prophylaxis strategy in spinal metastasis surgery.