Vol. 2, Issue 6 (2016)
The incidence of venous thromboembolism in neurosurgical patients: A retrospective quantitative analysis between 2007 and 2013 at Mater Dei Hospital, Malta
Author(s): Marija Agius, Shawn Agius, Karl Camilleri, Stephanie Azzopardi, Audrey Micallef
Abstract: Aim: Venous thromboembolism (VTE) causes increased morbidity and/ mortality to patients. Neurosurgical patients are at a particularly increased risk of deep venous thrombosis. The aim of this study was to establish a local venous thromboembolism rate and compare to international data.4, 3 Method: Clearance from patients’ consultants and data protection officer was obtained. A list of all the patients admitted between 1st January 2007 and 31st December 2013 was obtained. Patients were screened for ultrasound doppler, lower limb venogram, CT pulmonary angioram and ventilation perfusion scan results using iSOFT. The files of patients with positive imaging were reviewed. Results: There were a total of 1927 admissions between 2007 and 2013, sixteen (16) of whom had venous thrombosis and/or embolism. Eleven were females and five were males. Out of these, seven patients had undergone emergency cranial surgery – these included polytrauma patients. Five patients had elective spinal surgery. Thromboembolic prophylaxis had been prescribed in four of the seven patients who underwent cranial surgery and in three of the five patients who underwent spinal surgery. The timing of VTE was: two patients developed VTE 3- 5 days postoperatively, two patients between days 6-7; three patients one week post operatively, and nine patients presented with a VTE two or more weeks postoperatively. Eleven of the sixteen patients had been mobilised early, four had been prescribed thromboembolic deterrent (TED) stockings while one patient had an inferior vena cava (IVC) filter inserted. Postoperatively, low molecular weight heparin (LMWH) had been prescribed to ten patients while un-fractionated heparin was prescribed to one patient. Two patients suffered from a major postoperative bleed. One of these patients died within thirty- days of VTE diagnosis. Conclusion: Over the last seven years, the overall incidence of thromboembolic phenomena in the neurosurgical unit at Mater Dei Hospital was of 0.83%. This audit showed that the local incidence of thromboembolic events is comparable to that of other neurosurgical units which range from 0.29-7%.