PDF(Pubmed)
Abstract：
BACKGROUND: The management of perioperative venous thrombembolism (VTE) prophylaxis is highly variable between neurosurgical departments and general guidelines are missing. The main issue in debate are the dose and initiation time of pharmacologic VTE prevention to balance the risk of VTE-based morbidity and potentially life-threatening bleeding. Mechanical VTE prophylaxis with intermittend pneumatic compression (IPC), however, is established in only a few neurosurgical hospitals, and its efficacy has not yet been demonstrated. The objective of the present study was to analyze the risk of VTE before and after the implementation of IPC devices during elective neurosurgical procedures.
METHODS: All elective surgeries performed at our neurosurgical department between 01/2018-08/2022 were investigated regarding the occurrence of VTE. The VTE risk and associated mortality were compared between groups: (1) only chemoprophylaxis (CHEMO; surgeries 01/2018-04/2020) and (2) IPC and chemoprophylaxis (IPC; surgeries 04/2020-08/2022). Furthermore, general patient and disease characteristics as well as duration of hospitalization were evaluated and compared to the VTE risk.
RESULTS: VTE occurred after 38 elective procedures among > 12.000 surgeries. The number of VTEs significantly differed between groups with an incidence of 31/6663 (0.47%) in the CHEMO group and 7/6688 (0.1%) events in the IPC group. In both groups, patients with malignant brain tumors represented the largest proportion of patients, while VTEs in benign tumors occurred only in the CHEMO group.
CONCLUSIONS: The use of combined mechanical and pharmacologic VTE prophylaxis can significantly reduce the risk of postoperative thromboembolism after neurosurgical procedures and, therefore, reduce mortality and morbidity.
METHODS: All elective surgeries performed at our neurosurgical department between 01/2018-08/2022 were investigated regarding the occurrence of VTE. The VTE risk and associated mortality were compared between groups: (1) only chemoprophylaxis (CHEMO; surgeries 01/2018-04/2020) and (2) IPC and chemoprophylaxis (IPC; surgeries 04/2020-08/2022). Furthermore, general patient and disease characteristics as well as duration of hospitalization were evaluated and compared to the VTE risk.
RESULTS: VTE occurred after 38 elective procedures among > 12.000 surgeries. The number of VTEs significantly differed between groups with an incidence of 31/6663 (0.47%) in the CHEMO group and 7/6688 (0.1%) events in the IPC group. In both groups, patients with malignant brain tumors represented the largest proportion of patients, while VTEs in benign tumors occurred only in the CHEMO group.
CONCLUSIONS: The use of combined mechanical and pharmacologic VTE prophylaxis can significantly reduce the risk of postoperative thromboembolism after neurosurgical procedures and, therefore, reduce mortality and morbidity.
摘要：
背景：神经外科围手术期静脉血栓栓塞（VTE）预防的管理差异很大，缺乏一般指南。争论的主要问题是药物预防VTE的剂量和开始时间，以平衡基于VTE的发病率和潜在危及生命的出血的风险。间歇性气动压缩（IPC）的机械VTE预防，然而,仅在几家神经外科医院建立，其功效尚未得到证实。本研究的目的是分析在择期神经外科手术中实施IPC装置前后的VTE风险。
方法：2018年01月至2022年08月在我们神经外科进行的所有择期手术均对VTE的发生进行了调查。比较两组之间的VTE风险和相关死亡率：（1）仅化学预防（CHEMO;手术01/2018-04/2020）和（2）IPC和化学预防（IPC;手术04/2020-08/2022）。此外，对患者的一般情况和疾病特征以及住院时间进行评估,并与VTE风险进行比较.
结果：在12.000例手术中，38例择期手术后发生了VTE。两组之间的VTE数量显着不同，CHEMO组的发生率为31/6663（0.47％），IPC组的发生率为7/6688（0.1％）。在这两组中,恶性脑肿瘤患者占患者比例最大，而良性肿瘤中的VTEs仅发生在CHEMO组。
结论：使用机械和药物联合预防VTE可以显着降低神经外科手术后血栓栓塞的风险，因此,降低死亡率和发病率。
方法：2018年01月至2022年08月在我们神经外科进行的所有择期手术均对VTE的发生进行了调查。比较两组之间的VTE风险和相关死亡率：（1）仅化学预防（CHEMO;手术01/2018-04/2020）和（2）IPC和化学预防（IPC;手术04/2020-08/2022）。此外，对患者的一般情况和疾病特征以及住院时间进行评估,并与VTE风险进行比较.
结果：在12.000例手术中，38例择期手术后发生了VTE。两组之间的VTE数量显着不同，CHEMO组的发生率为31/6663（0.47％），IPC组的发生率为7/6688（0.1％）。在这两组中,恶性脑肿瘤患者占患者比例最大，而良性肿瘤中的VTEs仅发生在CHEMO组。
结论：使用机械和药物联合预防VTE可以显着降低神经外科手术后血栓栓塞的风险，因此,降低死亡率和发病率。
