Original ArticleClinically Diagnosed Postoperative Venous Thromboembolism in a Neurosurgery Practice in Nigeria
Introduction
Venous thromboembolism (VTE), including lower extremity deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a devastating postoperative complication with high rate of case fatality. Postoperatively, neurosurgical patients among all other in-hospital surgical cohorts are particularly prone to the complication, partly as the result of perioperative (pre- and postoperative) immobility that many neurologic illnesses predispose patients to, the long hours of surgery involved in many neurosurgical operative procedures, and the intrinsic biology of some neurosurgical lesions, including brain tumors like meningiomas, that appears to promote thrombogenesis.1, 2, 3
It has therefore been opined that the neurosurgeon has 3 practical problems regarding the issue of VTE: preventing DVT, diagnosing it, and treating it.3 Hence, several scientific studies and reviews from the developed countries show increasing efforts by neurosurgery units to address postoperative VTE along these 3-pronged directions, either singly or in combination.3, 4, 5, 6, 7, 8 In contrast, it appears that only scant attention, if any, is paid to this problem in the less-developed parts of the world. We are aware of only 1 report on the subject of postoperative VTE in contemporary literature from our region,9 but even this was only a questionnaire-based survey of practice of thromboprophylaxis among select surgeons. The report showed low awareness of the use of thromboprophylaxis among the study subjects.9 Thus, there appears to be no existing easily accessible literature in sub-Sahara Africa on the burden of postoperative VTE.
Sometime in the year 2009, a fatal, postmortem-confirmed VTE marked the unheralded catastrophic end to an otherwise-successful surgical resection of a cavernous sinus meningioma in our skull base surgery unit of a difficult practice setting in this region. One principle response this event elicited in our practice was a heightened vigilance to prevent this complication among our patient population and a prospective surveillance for its incidence. In this report a descriptive analysis of cases of VTE among a neurosurgical operative surgical cohort in this sub-Saharan African developing country is presented. The fatal index case also is illustrated.
Section snippets
Materials and Methods
This is a 6-year prospective observational study that used the prospective, consecutive database of the clinical records of all the patients who underwent neurosurgical operations, spinal or cranial, in the principal author's practice since the year 2009. The clinical records of all neurosurgical operative cases in which there was clinical evidence in keeping with VTE, with or without laboratory confirmation, were captured in clinical summary forms.
In this report, the clinical summary of 1
Case Illustration
A 43-year-old woman presented with a 3-year history of progressive blurring of vision that became total 6 months before our review. There was associated history of recurrent headache, galactorrhea of 3 years' duration, and amenorrhea of 1-year duration. Clinical examination revealed a young woman with normal mental status. She was blind bilaterally, visual acuity being nil light perception on the right side and hand movement on the left. Both pupils were 4 mm in diameter, nonreacting, and
Discussion
This study describes the clinical profiles of patients with clinically diagnosed postoperative VTE among a neurosurgical patient population from a developing country. It appears to be the first document of this nature on the subject from our region. There was a VTE rate of 2.4% and case fatality rate of 60%. Intracranial meningiomas were the lesions operated on in 60% of the cases, and 70% occurred among the female sex.
When in the year 2009, we had the rare chance of confirming with postmortem
Conclusions
This study reports on the clinical profiles of patients with clinically diagnosed postoperative VTE among a neurosurgical patient population from a developing country. It appears to be the first regional document on this subject. There was a VTE rate of 2.4% and case fatality rate of 60%. The only thromboprophylactic measures logistically available in this practice include perioperative ambulation in those who are able and graduated compression of the lower extremities using TED stockings and
References (20)
- et al.
Prophylaxis of venous thromboembolism. An overview
Chest
(1986) - et al.
Safety of deep venous thrombosis prophylaxis with low-molecular-weight heparin in brain surgery. Prospective study on 746 patients
Surg Neurol
(2008) - et al.
Prevention of venous thromboembolism in neurosurgery: a metaanalysis
Chest
(2008) - et al.
Mechanical prophylaxis of venous thrombosis in patients undergoing craniotomy: a randomized trial
Surg Neurol
(1989) - et al.
Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review
J Neurosurg
(1984) - et al.
Venous thromboembolism in neurosurgery and neurology patients: a review
Neurosurgery
(1994) - et al.
Efficacy of mechanical prophylaxis for venous thromboembolism in patients with brain tumors
Neurosurg Focus
(2004) - et al.
Incidence of venous thromboembolism in patients undergoing craniotomy and motor mapping for glioma without intraoperative mechanical prophylaxis to the contralateral leg
J Neurosurg
(2003) - et al.
Prevention of venous thromboembolism: focus on mechanical prophylaxis
Semin Thromb Hemost
(2011) - et al.
The use of thromboembolic prophylaxis by surgeons: a multicentre Nigerian study
Niger Postgrad Med J
(2007)
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.