discharge data from these institutions. Information in the cancer registry database included demographic data, the diagnosis date, the tumor histological type, the date and extent of cancer surgery, and the date of any initial radio- or chemotherapy. Histological groups were classified as GBM, AA, anaplastic oligodendroglioma, or other glioma (see Appendix for a complete list of tumors). Venous Thromboembolism Deep vein thrombosis and PE were defined using previously validated ICD-9-CM codes: 451.1x, 451.2, 451.81, 453.2, 453.8, 453.9, 415.1x in the principal or a
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Thomas J. Semrad, Robert O'Donnell, Ted Wun, Helen Chew, Danielle Harvey, Hong Zhou, and Richard H. White
Dominic A. Harris and Sandi Lam
T raumatic brain injury (TBI) is a major health problem among children and a leading cause of morbidity and mortality in the United States. 23 With nearly 7400 deaths, 60,000 hospitalizations, and 600,000 emergency department visits annually, TBIs in children impose a significant burden on our health care system. 25 In the adult population, a number of studies have found major trauma to be an independent risk factor for the development of venous thromboembolism (VTE) and pulmonary embolism. 5 , 20 , 27 Several factors may contribute to this, including
Ali K. Choucair, Pamela Silver, and Victor A. Levin
T he longer survival of patients with brain tumors has led to an increase in the number of complications related to the tumor or its treatment. The development of venous thromboembolism after neurosurgical operations is a significant problem, and there has been concern that treatment of this complication with anticoagulant drugs may increase the risk of intracranial hemorrhage. Swann and Black 7 and Powers and Edwards 5 have reviewed thromboembolism in the neurosurgical patient, and Brisman and Mendell 1 have discussed the relationship of thromboembolism
Ahmad Khaldi, Naseem Helo, Michael J. Schneck, and Thomas C. Origitano
Deep Vein Thrombosis Venous thromboembolism includes DVT and PE. Neurosurgical patients have an increased risk of developing VTE due to limb paralysis, stroke, and immobility as well as hypercoagulable states induced by certain neoplasms, such as astrocytoma. 9 The high rate of VTE in neurosurgical patients was related to malignant neoplasms (18%), trauma (12%), congestive heart failure (10%), central venous catheters (9%), neurological disease (7%), and superficial vein thrombosis (5%) in 1 series, and VTE in neurosurgical patients was associated with brain
Keaton Piper, Hanna Algattas, Ian A. DeAndrea-Lazarus, Kristopher T. Kimmell, Yan Michael Li, Kevin A. Walter, Howard J. Silberstein, and G. Edward Vates
reducing health care costs and preventing surgical complications. In 2006, the Centers for Medicare and Medicaid, in conjunction with organizations such as the Joint Commission and the Leapfrog Group, implemented the Surgical Care Improvement Project to reduce surgical complication rates. With hospital reimbursement now linked to surgical outcomes, hospitals have developed protocols for tracking and preventing surgical complications. 23 One core goal of the Surgical Care Improvement Project is to combat the development of venous thromboembolism (VTE), including
Kristopher T. Kimmell and Babak S. Jahromi
improvement. It is with this goal in mind that the Surgical Care Improvement Project (SCIP) was implemented in 2006. A key target of SCIP is prophylaxis against venous thromboembolism (VTE). With hospital reimbursement now tied directly to VTE prevention, hospital administrators have made prevention of VTE events a focus of new surgical protocols. However, this has created opposing incentives, whereby institutional desire to prevent reportable VTE episodes runs counter to surgeons' wishes to avoid hemorrhagic complications. In the neurosurgical literature, previous
Julian Prell, Jens Rachinger, Robert Smaczny, Bettina-Maria Taute, Stefan Rampp, Joerg Illert, Gershom Koman, Christian Marquart, Alexandra Rachinger, Sebastian Simmermacher, Alex Alfieri, Christian Scheller, and Christian Strauss
V enous thromboembolism has been designated the most important avoidable cause of mortality following neurosurgical procedures. 7 , 17 Venous thromboembolism (VTE) subsumes deep venous thrombosis (DVT) and pulmonary embolism (PE). Even asymptomatic DVT may lead to PE, 6 , 13 , 27 which proves lethal in up to 50% of affected neurosurgical patients. 13 , 17 Up to 7.5% of patients undergoing craniotomy have symptomatic DVT, 1 , 4 , 29 but DVT may be asymptomatically present in up to 50%. 9 , 13 Although low D-dimer plasma levels will rule out VTE with
J. Bridger Cox, Kristin J. Weaver, Daniel W. Neal, R. Patrick Jacob, and Daniel J. Hoh
was conducted. Additional factors, such as cost and clinical feasibility, were also considered. After several months of collaborative work, the “Adult Venous Thromboembolism Prophylaxis Order Form” was developed ( Fig. 1 ). It was approved by the Departments of Neurosurgery and Hematology at the University of Florida, Shands Hospital, and implemented in the spring of 2008. F ig . 1. Adult VTE-prophylaxis order form. CBC = complete blood count; CHF = congestive heart failure; CrCl = creatinine clearance; CVL = central venous line; INR = international
Julian Prell, Grit Schenk, Bettina-Maria Taute, Christian Scheller, Christian Marquart, Christian Strauss, and Stefan Rampp
Randomized controlled trial Evidence Class I Summary Statement This underpowered class I study suggests that the addition of intraoperative intermittent pneumatic compression (IPC) reduces the risk of venous thromboembolism (VTE) in patients undergoing intracranial surgery, but the difference in outcome did not reach statistical significance after adjustment for differences between treatment groups. Classification of Evidence Prell and colleagues deliver a rare commodity to the neurosurgical literature: a class I randomized controlled trial. Although one might
Katsuhito Yoshioka, Isao Kitajima, Tamon Kabata, Mineko Tani, Norio Kawahara, Hideki Murakami, Satoru Demura, Tsunehisa Tsubokawa, and Katsuro Tomita
. The other 2 were followed closely but did not require treatment. TABLE 1: Data in 6 patients with VTE * Case No. Diagnosis Procedure Approach Level Venous Thromboembolism Age (yrs), Sex Op Time (min) Intraop Blood Loss (ml) 1 lumbar disc herniation discectomy pst lumbar rt sural vein, lt soleus vein 68, F 155 10 2 spondylolisthesis PLIF pst lumbar lt sural vein, rt femoral vein 70, F 318 160 3 spondylolisthesis PLIF pst lumbar lt peroneal vein, PE 58, F 579 1510 4
