Elsevier

World Neurosurgery

Volume 89, May 2016, Pages 259-265
World Neurosurgery

Original Article
Clinically Diagnosed Postoperative Venous Thromboembolism in a Neurosurgery Practice in Nigeria

https://doi.org/10.1016/j.wneu.2016.01.069Get rights and content

Introduction

Postoperative venous thromboembolism (VTE) is a major surgical complication, fraught with high case fatality rate, to which neurosurgical patients are particularly prone. There is dearth of data on this problem in the neurosurgical literature from sub-Saharan Africa.

Materials and Methods

A 6-year prospective descriptive study of postoperative VTE in a neurosurgeon's clinical practice in Nigeria is hereby presented. The clinical case of a fatal, postmortem-confirmed post craniotomy VTE also is annotated.

Results

There were 10 cases of clinically diagnosed neurosurgical postoperative VTE, representing 2.4% of the surgical patients population. The cases were diagnosed from clinical impressions supplemented with laboratory investigations like the Doppler ultrasonography with B-mode imaging of the deep veins of the lower extremities, and chest computed tomographic angiography. Six of these 10 cases died, a case fatality rate of 60%. Meningiomas were the intracranial tumours operated on in 60% of the cases.

Conclusions

Postoperative venous thromboembolism has a very high case fatality rate among these neurosurgical patients. There is need for continuing surveillance of this problem, as well as a heightened vigilance to prevent and treat it in our neurosurgical patient populations.

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

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    Citation Excerpt :

    Another study by Zeng et al. [24] reported a 4.7% incidence of VTE in the elderly population, but more striking was that DVT and PE constituted a substantial 16.7% of all post-operative complications. The results from these studies and others [21,25] substantiate early mobilization of neurosurgical patients out of bed into a chair and ambulating as an acceptable measure to reduce the incidence of postoperative VTE in the elderly population. However, as discussed later, more caution should be taken with reinitiating anticoagulation therapy.

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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.

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