Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients

Abstract

Background: Deep venous thrombosis (DVT) contributes significantly to the morbidity and mortality of neurosurgical patients; however, no data regarding lower extremity DVT in postoperative Chinese neurosurgical patients have been reported.

Materials and methods: From January 2012 to December 2013, 196 patients without preoperative DVT who underwent neurosurgical operations were evaluated by color Doppler ultrasonography and D-dimer level measurements on the 3(rd), 7(th), and 14(th) days after surgery. Follow-up clinical data were recorded to determine the incidence of lower extremity DVT in postoperative neurosurgical patients and to analyze related clinical features. First, a single factor analysis, Chi-square test, was used to select statistically significant factors. Then, a multivariate analysis, binary logistic regression analysis, was used to determine risk factors for lower extremity DVT in postoperative neurosurgical patients.

Results: Lower extremity DVT occurred in 61 patients, and the incidence of DVT was 31.1% in the enrolled Chinese neurosurgical patients. The common symptoms of DVT were limb swelling and lower extremity pain as well as increased soft tissue tension. The common sites of venous involvement were the calf muscle and peroneal and posterior tibial veins. The single factor analysis showed statistically significant differences in DVT risk factors, including age, hypertension, smoking status, operation time, a bedridden or paralyzed state, the presence of a tumor, postoperative dehydration, and glucocorticoid treatment, between the two groups (P < 0.05). The binary logistic regression analysis showed that an age greater than 50 years, hypertension, a bedridden or paralyzed state, the presence of a tumor, and postoperative dehydration were risk factors for lower extremity DVT in postoperative neurosurgical patients.

Conclusions: Lower extremity DVT was a common complication following craniotomy in the enrolled Chinese neurosurgical patients. Multiple factors were identified as predictive of DVT in neurosurgical patients, including the presence of a tumor, an age greater than 50 years, hypertension, and immobility.

Keywords: Anterior tibial vein; common femoral vein; deep femoral vein; deep venous thrombosis; posterior tibial vein; superficial femoral vein.

Figure 1

Preoperative contrast-enhanced T1MRI showing tuberculum sellae meningioma on axial (a) and sagittal (b) planes; postoperative contrast-enhanced T1MRI showing complete resection at 3 days after operation on axial (c) and sagittal (d) planes. The left lower extremity swelling occurred at 7 days (e), and color Doppler ultrasound detected deep venous thrombosis in common femoral vein, superficial vein and deep femoral vein (f)

Figure 2

Bar graph showing the vein segment involved in deep venous thrombosis after craniotomy