Flinn WR, Sandager GP, Silva MB Jr, Benjamin ME, Cerullo LJ, Taylor M.
Prospective surveillance for perioperative venous thrombosis. Experience in 2643
patients.
Arch Surg 1996 May;131(5):472-80

Department of Surgery, University of Maryland Medical School, Baltimore, USA.

BACKGROUND: Patients who undergo neurosurgical procedures are at high risk for
perioperative deep vein thrombosis (DVT) and pulmonary embolism (PE), which have
been reported in 6% to 43% of these patients. OBJECTIVES: To (1) determine the
utility of prospective DVT surveillance in patients who undergo neurosurgical
procedures by using venous duplex ultrasound scanning (VDUS), (2) assess the
efficacy of DVT prophylaxis (elastic stockings and intermittent pneumatic
compression), (3) identify subgroups of patients who are at higher risk, and (4)
determine whether DVT surveillance would reduce the incidence of fatal PE.
DESIGN: All patients had undergone preoperative VDUS of both lower extremities,
and postoperative VDUS was performed on days 3 and 7, and weekly thereafter until
patients were ambulatory or discharged. PATIENTS: During a 5-year period, 2643
patients who underwent neurosurgical procedures were enrolled in prospective DVT
surveillance. SETTING: University-affiliated community hospital. RESULTS: Acute
DVT was diagnosed in 147 (5.6%) of the 2643 patients. Eighty-one percent of the
patients with acute DVT were asymptomatic at the time of diagnosis. Deep vein
thrombosis developed de novo in the proximal veins in 98% of the patients.
Patients in whom a craniotomy was done had a significantly higher risk for DVT
(7.7%, P = .006), and patients who underwent cervical or lumbar spinal surgical
procedures had a significantly lower risk (1.5%, P < .001). Among those patients
in whom a craniotomy was performed for treatment of a tumor and who had DVT, 87%
had malignant neoplasms. Significant lower-extremity neuromotor dysfunction was
present in 69% of all patients with DVT, and this finding predominated among
patients with DVT in the subgroups with a lower risk. A PE was diagnosed in 5
patients (0.19%) while they were hospitalized, and a PE was fatal in 2 (0.07% of
all patients). CONCLUSIONS: Most perioperative DVTs were clinically silent and
formed spontaneously in proximal venous segments where there would be a risk for
a PE. The overall incidence of DVT (5.6%) was low, suggesting effective DVT
prophylaxis. Patients who underwent spinal surgical procedures were at a
significantly lower risk for DVT, and future surveillance is not indicated in
this patient group unless other conditions exist (paralysis, malignancy).
Patients in whom a craniotomy was performed had a significantly higher risk of
DVT, particularly when other risk factors existed. The low incidence of a fatal
PE (0.07%) reflected that early detection and treatment of proximal DVT were
facilitated by prospective VDUS surveillance in these patients.