Differences of venous thromboembolic risks in vascular general and trauma surgery patients.
OBJECTIVE
Venous thromboembolism (VTE) is a common complication in patients undergoing surgery. The risk for VTE is determined by the combination of individual predisposing factors and features of the specific type of surgery. Although the knowledge about VTE has increased enormously during the last years VTE-prophylaxis is still inadequate. The goals of our study were to assess the correctness of the adjusted pharmacological prophylaxis, and the difference of the VTE-risks in the different surgical departments.


METHODS
During a three months period, 451 patients were prospective included. These patients were admitted to the Departments of Vascular and General Surgery and of Traumatology of our hospital. Based on the modified Hertfelder's VTE-risk-assessment model, we scored the patients and categorized them into 4 groups: low, moderate, high and very high risk for VTE. We enrolled every admitted patient taking their medical history and reviewing medical documents.


RESULTS
The mean cumulative risk value for VTE-risk was 3.68 (median 3.5, minimum: 0, maximum: 13 and standard deviation: 2.206), whereas 20.2% of our patients had a low, 27.2% middle, 21.7% high and 30.9% very high risk. The patients with vascular procedures had significantly higher mean value (5.03, SD 2.2) than the patients with general operations (3.6, SD 2.2) and those who underwent traumatology (3.06, SD 1,8) (P value <0.001). The majority of patients (n=356), (78.9%) received VTE-prophylaxis with low dose of low molecular weight heparin (LMWH). Of the remaining patients, 40 (8.9%) received therapeutic dose and 55 (12.2%) received none VTE-prophylaxis.


CONCLUSIONS
The VTE-risk for surgical patients remains high, despite all efforts for prophylaxis. The main reason may be that risk-assessment is time consuming and not standardized. We demonstrated that VTE-risk for patients in vascular surgery is significantly higher than the VTE-risk for patients in general and trauma surgery. We also showed that the VTE-risk in some patients was underestimated and prophylaxis was inadequate. Therefore, it is recommended to emphasize more on short risk-assessment, adequate prophylaxis and optimal dosage in order to prevent deep venous thrombosis and embolism disease.
Mommertz
G
G
Department of Vascular Surgery, University Hospital, Aachen, Germany. gmommertz@ukaachen.de
Sigala
F
F
Glowka
T R
TR
Sigalas
P
P
Langer
S
S
Koeppel
T
T
Michels
A
A
Jacobs
M J
MJ
D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000008:administration & dosage; D016009:Chi-Square Distribution; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D013924:Thrombophlebitis / Q000209:etiology* / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight