The new algorithm for stratification of the risk of venous thromboembolic events in elective neurosurgery and its prognostic significance

Abstract

Early identification of risk groups is essential for effective and target prevention of venous thromboembolic events (VTE) in all areas of surgery. For this purpose, the authors has developed and put into practice an algorithm distinguishing the groups of low, moderate and high risk of VTE among neurosurgical patients. Objective. To assess predictive value of the developed algorithm for elective neurosurgical interventions. Material and methods. The study included 7914 patients who underwent surgery between January 2018 and December 2019. According to the algorithm, we identified the groups of low (1536 (19%) patients), moderate (4554 (58%) patients) and high risk (1824 (23%) patients). Moreover, patients were divided into subgroups depending on surgical procedure. We analyzed the incidence of VTE and mortality in all groups. Results. Incidence of VTE with a 95% confidence interval in the low-risk group was 0.65% [0.26; 1.04], in the moderate risk group — 1.82% [1.47; 2.24], in the high-risk group — 12.61% [11.02; 14.09]. When comparing various surgical interventions, we revealed more common VTE after vascular microsurgery (15.62%), in patients with brain tumors (12.63%) and spinal cord tumors (6.52%). Conclusion. The risk stratification algorithm has demonstrated its convenience and significant predictive value for determining the risk of VTE among elective neurosurgical patients. In addition, different incidence of VTE was demonstrated in patients with various neurosurgical diseases.