gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Current practice in the perioperative prevention of thromboembolism in German neurosurgical departments – an update

Meeting Abstract

  • J. Rachinger - Klinik für Neurochirurgie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
  • G. Koman - Klinik für Neurochirurgie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
  • C. Scheller - Klinik für Neurochirurgie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
  • J. Prell - Klinik für Neurochirurgie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
  • C. Strauss - Klinik für Neurochirurgie, Klinikum der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.08-03

DOI: 10.3205/09dgnc164, URN: urn:nbn:de:0183-09dgnc1642

Published: May 20, 2009

© 2009 Rachinger et al.
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Outline

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Objective: To provide an overview of the current practice in perioperative prophylaxis of thromboembolism in German neurosurgery and to answer the question if seven years after the survey of Raabe et al a harmonization of standards can be observed.

Methods: Questionnaires were sent to 130 German neurosurgical departments. Questions concerned beginning and duration of heparin application (fractionated/unfractionated), heparin doses and the use of compression stockings. These data were collected separately for spinal-intradural, spinal-extradural and intracranial procedures. Intracranial operations were divided in procedures for haematoma and those for tumor or vascular malformations. Furthermore, neurosurgeons were asked for their subjective opinion on the usefulness and the potential risks of perioperative heparin application depending on the time of its beginning.

Results: 103 questionnaires suitable for analysis were sent back. However, not all questions were answered by all participants. In 1 clinic no heparin was administered at all, 13 clinics use heparin only in certain procedures, 89 routinely in all listed interventions. In extradural spinal interventions, 102 clinics administer a low molecular weight heparin (LMWH), in intradural 99, in intracranial surgery for tumor removal 95 clinics, in intracranial haematoma evacuation 86. In extradural spinal procedures 64 departments begin LMWH-administration preoperatively (intradural: 52), 8 on the day of surgery (intradural: 8), 28 on the 1st postoperative day (intradural: 33), 1 on the 2nd postoperative day (intradural: 2). In intradural spinal procedures 3 departments start LMWH on the 3rd postoperative day and 1 on the 5th postoperative day. In intracranial tumor removal 35 clinics begin administration preoperatively (haematoma: 26), 6 clinics on the day of surgery (haematoma: 15), 37 clinics on the 1st postoperative day (haematoma: 32), 7 clinics on the 2nd postoperative day (haematoma: 5), 7 on the 3rd postoperative day (haematoma: 10), 1 on the 4th postoperative day (haematoma: 3), 3 on the 5th postoperative day (haematoma: 5). Concerning the subjective assessment of risks and benefits of perioperative heparin application a wide range of opinions could be observed.

Conclusions: Today, the perioperative use of LMWH is widely accepted in German neurosurgical departments. However, the ideal timing to optimally balance potential risks and benefits seems to be still unclear. A prospective study has to be discussed.