Venous thromboembolism: risk factors in the craniotomy patient population

The purpose of the study was to determine risk factors for the development of venous thromboembolism in the craniotomy population. Four hundred forty-three patients who under went craniotomy surgery were enrolled in the study. Patients were assessed daily during their postoperative recovery and at the 6-week return postoperative visit for signs and symptoms of thromboembolism. Those not returning for a checkup received a call which asked about the occurrence of signs and symptoms. Chart audits were completed to gather data on risk factors and thromboembolism characteristics. Risk factors included demographic, clinical history, lab, medications, intraoperative and postoperative variables. Deep venous thrombosis and pulmonary embolus symptomatology were also evaluated. Forty-four patients (10%) developed a thrombosis during hospitalization or during the 6 week recovery. The diagnosis was confirmed by duplex scan or venogram. Multiple vessels were the most frequent site. Only 22.7% of the patients had symptoms. Significant risk factors included: presence of leg weakness (p = 0.05), longer LOS (p = 0.0001), more postoperative ICU days (p = 0.001), more preoperative ICU days (p = 0.01), longer recovery time in PACU (p = 0.03), and a longer postoperative period to initiate all activities, ROM, chair, BRP, and ambulating in hall (p = < 0.01). Venous thromboembolism increases morbidity, mortality and health care costs. A risk profile can assist nurses in targeting patients for additional preventive interventions.