Evidence-based information is needed to optimize medical decision making and subsequent treatment outcomes. For those circumstances where strong evidence is lacking, determination of evidence-based appropriateness of individual treatment can be challenging. The North American Spine Society (NASS) has concurrently completed a Clinical Practice Guideline (CPG) for use of antithrombotic therapy in adults undergoing spine surgery. The purpose of the guideline is to provide evidence-based recommendations to address key clinical questions surrounding the prevention of venous thromboembolism (VTE). Guidelines provide recommendations based on a strict analytical process, and strength of the recommendations are based solely on the quality of the literature for each developed question. Through a comprehensive literature review and an extensive vetting process, they provide information where high-quality evidence exists, and highlight knowledge gaps. They do not provide recommendations for which there is little or no evidence.

Appropriate Use Criteria (AUC) are used in NASS and other specialty organizations as a means of determining appropriate recommendations for medical care. Accepted methodology was developed to determine reasonable recommendations for treatments.1 While high level evidence is ideal, an AUC allows for recommendations to be developed regardless of the available level of evidence. AUC specify when it is appropriate to utilize an intervention or diagnostic test. They are developed based on available evidence combined with a rigorous, transparent recommendation process using well-defined scenarios while considering the relative balance of potential benefit and harm of a procedure. Recommendations are arguably most accurate for those procedures that have high level evidence and wide consensus. Importantly, however, they can be developed regardless of quality of evidence, and thus have an intrinsic added value.

The objective of the NASS AUC is to define appropriate (or reasonable) care for spinal disorders. This document outlines the development and results of AUC for antithrombotic therapy following spine surgery.