Postoperative pulmonary embolism in neurosurgical patients: increased mortality factors and prevention
DOI:
https://doi.org/10.25305/unj.72608Keywords:
pulmonary embolism, neurosurgical patients, postoperative period, risk factors for increased mortalityAbstract
Objectives: Propose methods of prevention of thromboembolic complications in neurosurgical patients in the postoperative period, taking into account risk factors for death due to pulmonary embolism (PE).
Materials and methods. We made a retrospective study of the clinical histories of 163 neurosurgical patients operated between 2010 and 2014. Patients were divided into two groups: the first consisted of patients who died in the postoperative period due to pulmonary embolism (n=63), second (control) - patients in the postoperative period and at discharge had no thromboembolic complications (n=100).
Results. No gender differences are found, death due to thromboembolic complication occurs equally in men and women (relative risk — RR=1; 95% confidence interval — CI 0.68–1.48; p=0.99).
The risk of death from pulmonary embolism at the patient aged 41-60 is higher in 2 times than the patient aged 18-40 (RR=2.00; 95% CI 0.94–4.26; p=0.07), in patients older than 60 years of age is higher in 2.5 times than the patients aged 18-40 (RR=2.50; 95% CI 1.14–5.47; p=0.02).
Patients with thrombophlebitis of lower extremities due to pulmonary embolism die almost three times more than in its absence (RR=2.98; 95% CI 2.29–3.8; p=0.00); likely to die in the postoperative period due to pulmonary embolism in patients with hypertension in 2.61 higher than in patients with normal pressure (RR=2.61; 95% CI 1.64–4.15; p=0.00); atrial fibrillation and flutter increases the risk of death from pulmonary embolism in more than 2 times compared with patients who did not have such pathology (RR=2.11; 95% CI 1.48-2.99; p=0.00).
High hematocrit levels and diabetes increase the risk of death from pulmonary embolism in 1.4 and 1.21 times (respectively). But P value of 0.09 and 0.56 is non-statistically significant results at an alpha level of 0.05. Also the lower limit of the CI (0.96 and 0.65) does not cross the line no effect (1.0). Therefore this factors that actually effect slightly, but finality of this conclusion needs further study.
Obesity is not a risk factor for death from pulmonary embolism (RR=0.92; 95% CI 0.52–1.61; р=0.77).
Conclusions. 1. Significant factors for increased risk of death from pulmonary embolism in patients with neurosurgical disorders are age over 40 years, thrombophlebitis of lower limbs, hypertension and arrhythmia or atrial fibrillation; diabetes and elevated hematocrit levels not significantly increase the risk of death from pulmonary embolism; gender and obesity did not increase the risk of death from pulmonary embolism.
2. In order to prevent the death of neurosurgical patients due to pulmonary embolism depending on the risk groups we recommend: elastic graduated compression stockings in preoperative, intraoperative and postoperative phases; early and frequent ambulation; adequate hydration; intermittent pneumatic compression; use low molecular weight heparin (LMWH) and unfractionated heparin (UFH) later a few days after surgery at the stabilization of hemostasis and under the strict control of blood coagulation.
References
1. Grosse SD, Nelson RE, Nyarko KA, Richardson LC, Raskob GE. The economic burden of incident venous thromboembolism in the United States: A review of estimated attributable healthcare costs. Thromb Res. 2016;137:3-10. [CrossRef] [PubMed]
2. Schraufnagel DE. Chapter 16. Pulmonary Embolism. In: Schraufnagel DE, editor. Breathing in America: diseases, progress, and hope. New York: American Thoracic Society; 2014. http://www.thoracic.org/patients/patient-resources/breathing-in-america/resources/chapter-16-pulmonary-embolism.pdf
3. Tsai J, Grosse SD, Grant AM, Hooper WC, Atrash HK. Trends in in-hospital deaths among hospitalizations with pulmonary embolism. Arch Intern Med. 2012;172(12):960-1. [CrossRef] [PubMed]
4. Pavlova TV, Saveliev GG, Duplyakov DV Kurakin EA. Profilaktika i lecheniye tromboembolii legochnoy arterii dlya vrachey pervichnogo zvena: informatsionno-instruktivnyye materialy [Prevention and treatment of pulmonary embolism for primary care physicians. Information and guidance materials]. Samara: Samara Regional Center for Medical Prevention; 2007. Russian. http://bono-esse.ru/blizzard/RPP/M/SSZ/profilaktika_i_lechenie_tromboembolii_legochnoy_arterii.pdf
5. Vertkin AL, Gritsanchuk AM. Venoznyye trombozy i embolii: epidemiya, o kotoroy bolshe molchat nelzya! [Venous thrombosis and embolism: the epidemic, which can not keep silent any longer!]. Doktor Ru. 2014;(S5(9):59-66. Russian. http://elibrary.ru/item.asp?id=23388321
6. Lyashenko AN, Tsiryateva SB. Faktory riska vozniknoveniya venoznogo tromboembolizma [Risk factors for venous thromboembolism]. Universitetskaya meditsina Urala. 2015;1(1):19-23. Russian. http://elibrary.ru/item.asp?id=25221556
7. Bokarev IN, Popova LV. Venoznyy tromboembolizm i tromboemboliya legochnoy arterii [Venous thromboembolism and pulmonary embolism]. Moscow: Meditsinskoye informatsionnoye agentstvo; 2013. Russian.
8. Kirienko AI, Panchenko EP, Andriyashkin VV. Venoznyy tromboz v praktike terapevta i khirurga [Venous thrombosis in the practice of physician and surgeon]. Moscow: Planida, 2012. Russian.
9. Khondkaryan EV. Algoritmy klinicheskoy veroyatnosti tromboembolii legochnoy arterii [Clinical probability algorithms for pulmonary embolism]. Bulletin of Medical Internet Conferences. 2015;5(5):392. Russian. http://cyberleninka.ru/article/n/algoritmy-klinicheskoy-veroyatnosti-tromboembolii-legochnoy-arterii
10. Venoznyy tromboembolizm: diahnostyka, likuvannya, profilaktyka: mizhdystsyplinarni klinichni rekomendatsiyi [Venous thromboembolism: diagnosis, treatment, prevention, interdisciplinary clinical recommendations]. Kyiv, 2011. 63 p. Ukrainian. http://trombosov.net.ua/img/Download/clinic_recomed.pdf
11. Pristrom AM, Tyabut TD, Sukalo YeA, Rachok SM, Mikhno MM. Tromboemboliya legochnoy arterii: ucheb.-metod. posobiye [Pulmonary embolism: training manual]. Minsk: BelMAPO, 2011. Russian. http://belmapo.by/downloads/cardiology/2012/trombolimboliua.pdf
12. Lazarenko A. Tromboemboliya legochnoy arterii: sovremennyye aspekty profilaktiki, diagnostiki i lecheniya [Pulmonary embolism: modern aspects of prevention, diagnosis and treatment]. Zdorov’ya Ukrayiny. 2010;(11-12):240-1. Russian. http://health-ua.com/pics/pdf/2010_11_12/30-31.pdf
13. Essam AE, Sharif G, Al-Hameed F. Venous thromboembolism-related mortality and morbidity in King Fahd General Hospital, Jeddah, Kingdom of Saudi Arabia. Ann Thorac Med. 2011 Oct;6(4):193-8. [CrossRef] [PubMed]
14. Rossiyskiye klinicheskiye rekomendatsii po diagnostike, lecheniyu i profilaktike venoznykh tromboembolicheskikh oslozhneniy [The Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolic events]. Flebologiya. 2010;4(2-1):2-37. Russian. http://webmed.irkutsk.ru/doc/pdf/pe2010.pdf
15. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):381S-453S. [CrossRef] [PubMed]
16. Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163(14):1711-7. [CrossRef] [PubMed]
17. Obanolu U. Risk Factor for Pulmonary Embolism. Pulmonary Embolism [Internet]. InTech; 2012 Mar 14. [CrossRef]
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Sergiy Minov, Anna Nikiforova, Viktor Yatsyk, Oleksandr Parkhomenko, Olena Mironenko, Oleksandr Zhurahivskiy, Igor Rostotskiy, Dmytro Kuzmenko
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.
