Audit of Perioperative Prescription of LMWH in Spinal Surgery at The Royal National Orthopaedic Hospital

Sarah Elmadbouh

Introduction
Spinal surgery patients are at increased risk of venous thromboembolism (VTE) due to prolonged operative times and reduced postoperative mobility. Conversely, early administration of low molecular weight heparin (LMWH) increases the risk of spinal or epidural haematoma with potentially devastating neurological consequences. Appropriate timing of LMWH is therefore critical. This audit aimed to evaluate compliance with local guidelines for postoperative LMWH timing in spinal surgery patients at a tertiary orthopaedic centre.

Methods
A retrospective audit was conducted using electronic patient records over a fourmonth period (August–November 2025). Postoperative surgical plans and medication charts were reviewed to assess whether LMWH was administered within the locally recommended postoperative timing window. All adult patients undergoing spinal surgery during the study period were included. Compliance was defined as LMWH administration within the prescribed timeframe documented in the postoperative plan.

Results
Twenty-seven patients were included. LMWH was administered within the correct postoperative timeframe in 22 patients (81.5%), demonstrating good overall compliance with local guidelines. Five patients (18.5%) experienced delays in LMWH administration. Timely administration was consistently associated with clear documentation of LMWH timing and effective nursing handover. Delays were mostly linked to inconsistent documentation and communication gaps during handover.

Conclusions
While compliance with LMWH timing guidelines was high overall, nearly one in five patients experienced delays, representing a clinically significant safety risk. Targeted interventions including standardised postoperative documentation, strengthened handover processes, staff education, and electronic prompts are
planned. A re-audit will assess the impact of these measures on guideline adherence and patient safety.

Authors
Sarah Elmadbouh, Kamil Kose, Moustafa Ibrahim, Naila Begum
Royal National Orthopaedic Hospital, Middlessex, United Kingdom