Deep vein thrombosis and pulmonary embolism in neurosurgical patients

Abstract

Objective: Venous thromboembolism (VTE), comprised of deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a major risk of illness and death in neurosurgical patients. This study aims to determine the incidence of VTE in neurosurgical patients, investigate the risk factors for their development.

Methods: All admission records of neurosurgical patients between 1st January 2023 and 31st December 2023 to our centre were reviewed retrospectively to identify cases of VTE. Patient demographics, surgical details, postoperative immobilization, and risk factors were recorded and analysed using logistic regression analyses.

Results: A total of 1,000 neurosurgical patients were included, with 27 (2.7%) developing VTE, comprising 5 (0.5%) DVT and 22 (2.2%) PE. Univariate analysis revealed hypotension (OR: 84.43, p < 0.001), tachycardia (OR: 68.43, p < 0.001), SpO2 <90% (OR: 19.38, p < 0.001), respiratory rate >30 per minute (OR: 9.65, p = 0.005), surgery during admission (OR: 3.77, p = 0.002), prolonged hospital stay (OR: 1.04, p < 0.001), and low Glasgow Coma Scale (GCS) upon admission (OR: 0.84, p < 0.001) as significant predictors of VTE. Multivariate analysis determined three independent risk factors: tachycardia (adjusted OR: 28.61, p < 0.001), prolonged hospital stay (adjusted OR: 1.03, p < 0.001), and paralysis or lower extremity immobilization (adjusted OR: 5.53, p = 0.007).

Conclusion: Paralysis or lower extremity immobilization, prolonged hospital stays, and tachycardia are independent predictors of VTE in neurosurgical patients. Identifying high risk patients based on risk factors and implementing individualized thromboprophylaxis strategies is crucial to reduce morbidity and mortality.