Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
It also gives due credit to all research designs like descriptive and qualitative studies while many journals ignore these important study designs. The rigorous review process does not allow any compromise in quality
It is indexed in many indexing agencies and the articles are available under creative commons licence free of cost
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It's wide scope welcomes articles across various specialities in medicine. In an era when there is an unscientific insistence on speciality specific research by regulatory bodies in medical education, JCDR supports collaborative research across specialities. I wish the publisher all the best in his future endeavors."



Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3120 - 3127

The Incidence Of Deep Vein Thrombosis In Post Operative Patients In A Large South Indian Tertiary Care Centre

TAURO L F*, GEORGE C**, RAO BSS SHENOY D H***, AITHALA P S****, HEGDE B R*****

*M.S, Addl. Professor, **M S, Asst. Professor, ***MS, MRCSEd, Assoc. Professor, ****M S, Professor, *****MS, FICS, Professor, ******M S, FRCS, Professor, Department of General Surgery, Fr. Muller Medical College Hospital, Kankanady, Mangalore – 2, Karnataka, India

Correspondence Address :
Dr. Leo F. Tauro
Department of General Surgery
Fr. Muller Medical College Hospital
Kankanady, Mangalore – 2. D.K.
Karnataka, India
Ph.No: Hosp: (0824) 2436301, Res: (0824) 2224911
E-Mail – drlftauro@rediffmail.com


Abstract

Objective: To determine the incidence of deep vein thrombosis (DVT) in postoperative patients after major abdominal, orthopaedic and neurosurgical procedures, which require long term postoperative hospital stay and to identify the risk factors for DVT in these patients.
Materials and Methods: This is a prospective study done in our medical college’s hospital from July 2004 - June 2006. The patients were chosen from all the major branches of surgery, provided they were selected to undergo major surgical procedures requiring prolonged hospital stay after surgery. They were all over the age of 30 years and were routinely assessed for deep vein thrombosis by duplex scan pre and post operatively.
Results: A total number of one hundred patients were studied. Out of them, 60 were males and 40 were females. The patients were between the age groups of 30 – 91 years (the mean age was 53 years). Out of 100 postoperative patients, deep vein thrombosis was observed in 14 patients; out of these, 7 were from general surgery, 4 were from neurosurgery and 3 were from orthopaedics. In this study, out of 76 patients who underwent surgery under general anaesthesia, 9 patients developed DVT and out of 24 patients who underwent surgery under spinal anaesthesia, 5 developed DVT.
Conclusion: In this study, the incidence of deep vein thrombosis in postoperative patients was found to be 14 % (as compared to 34-63% in the Western population). The incidence of DVT in our study (14%) is significant enough to advocate prophylactic anticoagulant therapy to those who have to undergo major surgical procedures and those who have risk factors.

Keywords

Deep vein thrombosis, venous thromboembolism, pulmonary embolism, Postoperative complications, Fibrinolysis.

How to cite this article :

TAURO L F, GEORGE C, RAO BSS SHENOY D H, AITHALA P S, HEGDE B R. THE INCIDENCE OF DEEP VEIN THROMBOSIS IN POST OPERATIVE PATIENTS IN A LARGE SOUTH INDIAN TERTIARY CARE CENTRE. Journal of Clinical and Diagnostic Research [serial online] 2010 October [cited: 2019 Aug 25 ]; 4:3120-3127. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2010&month=October&volume=4&issue=5&page=3120-3127&id=947

Introduction
Deep vein thrombosis (DVT) remains a common and serious medical condition, frequently complicating the post operative recovery of surgical patients or manifesting denovo in patients with recognized risk factors. Thromboembolism remains a serious preventable cause of postoperative morbidity and mortality in the western world. It is estimated that 20 million cases of lower extremity deep vein thrombosis occur in the USA alone (1). Routine postoperative venography has shown an incidence of 60% in patients undergoing orthopaedic surgery, with the highest rates seen in patients undergoing total knee arthroplasty (2). Undiagnosed and untreated DVT of the lower extremities accounts for the vast majority of the 600000 cases of pulmonary embolism in USA each year (1). The incidence of Deep vein thrombosis varies in different parts of the world, for reasons that are not yet completely understood (3).

The prevalence of DVT in surgical patients is 10% to 80%, depending on the type of surgery and the individual patient risk factors. It is generally accepted that postoperative DVT is rare in Asians (4). However, sufficient data on the prevalence of DVT in the population is still lacking. A review of literature revealed very few studies, mainly from the South East Asian countries and all of them have placed the incidence in the range of 6% to 75% (2).

Objectives
To study the incidence of Deep Vein thrombosis after major abdominal, orthopaedic and neurosurgical procedures requiring long-term post operative hospital stay and to identify the risk factors for DVT.

Material and Methods

This study included 100 patients who were admitted in the departments of general surgery, orthopaedics and neurosurgery in our hospital during the period of July 2004 to June 2006. Ethical committee clearance and informed consent was taken. The patients were chosen from those who were selected to undergo major abdominal, orthopaedic and neurosurgical procedures. None of these patients were taking aspirin, aspirin containing compounds or other anticoagulant medications.

Inclusion criteria: (1) Patients over 30 years scheduled for major abdominal, orthopaedics and neurosurgeries. (2) Expected operating time of more than 60 minutes. (3) Estimated post operative stay of more than 7 days.

Exclusion Criteria: (1) Patients on anticoagulant therapy, immediately prior to admission. (2) Patients with a known history of bleeding diathesis, with prolonged prothrombin time and prolonged bleeding and clotting time. (3) Patients who had suffered a single or multiple haemorrhagic episodes within the previous 3 months, which were unrelated to the surgical procedure. (4) Patients with thrombocytopaenia. (5) Septicaemic patients. (6) Patients with disseminated intravascular coagulation (DIC).

Method: A detailed history regarding diseases like diabetes mellitus, hypertension, varicose veins, cardiac diseases, peripheral vascular disease, lower limb paralysis, cerebrovascular accidents, malignant diseases, leg oedema, etc, was taken. Information regarding smoking and alcohol intake, the prolonged use of steroids, hormones, and contraceptives and obstetric history was also obtained. Details of the operative procedure, duration of the surgery, position of the patient, the amount of intra operative blood loss, postoperative immobilization and the type of anaesthesia used were recorded. A thorough clinical examination of the patient was performed, with particular attention to note anaemia, nutritional status, cardiac status, the calf circumferences and pain or swelling over the calves. Apart from the routine investigations, bleeding and clotting profiles, renal profiles, ECG, chest X ray, etc, were obtained one day prior to surgery. The Duplex Scan of both lower limbs and coagulation profiles were repeated on the 5th post operative day.
The parameters which were assessed were age, sex and anaesthesia time. Intra operative bleeding was assessed subjectively and was classified as mild, moderate and severe. Any amount of bleeding that necessitated intra and post operative blood transfusion was considered to be severe.

Post operative period: During the immediate post operative period
- Observation was done for temperature and tachycardia. The calf circumferences of both lower limbs were measured. Any pain or swelling of the calves was noted.
- Patients were instructed on techniques of deep breathing, leg exercise; especially isometric ankle flexion exercises which were encouraged post operatively. All patients received physiotherapy from the first post operative day.
Duplex scanning was used as the definitive test for venous thrombosis. It was done a day before the operation, during the immediate post operative period, during the early post operative period and 7-14 days after the operation.

The diagnosis of DVT was made if any of the following Sonographical criteria were seen: Sonographical visualization of the thrombus in the vein, loss of compressibility of the vein by ultrasonic probe pressure, loss of phasic flow signal or loss of augmentation of the flow with distal compression.

Results

A total number of one hundred patients were studied; out of them, 60 were males and 40 were females. The patients were between the age groups of 30 – 91 years, the mean age being 53 years (Table/Fig 1).

Out of 76 patients who underwent general anaesthesia, 9 patients (11.8%) developed DVT and out of 24 patients who underwent spinal anaesthesia, 5 developed DVT (20.8%).

DVT was observed in 14 patients in our study, the occurrence being 14% in 7 male and 7 female patients (Table/Fig 2).

(Table/Fig 2): Incidence of DVT among Gender

Out of these 14 positive cases, 7 were from general surgery (2- abdomino-perineal resection, 1- laparotomy for intestinal obstruction, 2- anterior resection, 1- hemicolectomy and 1- whipple’s operation), 4 were from neurosurgery (all brain tumours) and 3 were from orthopaedics (2 total hip replacement and 1 multiple bones fracture with pelvic fracture) (Table/Fig 3).

(Table/Fig 3): Incidence of DVT under different type of Surgery

Out of 14 patients, 8 patients had platelet count > 3.5 lakhs (57%) and 6 had platelet count < 3.5 lakhs (43%). (Table/Fig 4): Duration of anaesthesia wise distribution
Out of 100 cases, 74 surgeries were completed within one to three hours, while 26 procedures took more than 3 hours; the maximum time being 12 hours (Table/Fig 4).

The average stay of those who proved positive for post operative DVT was 25 days, the minimum being 11 days and the maximum being 76 days. The average anaesthesia time for those who developed DVT was 3.45 hours, with a minimum 1.30 hours and a maximum of 12 hours. One of our patients expired in the early postoperative period. The clinical features were strongly suggestive of pulmonary thromboembolic disease. This patient was 70 years of age and he had undergone laparotomy for intestinal obstruction.

Discussion

Venous thromboembolic disease is a major cause of morbidity and mortality in general surgery, orthopaedics and neurosurgery. In the Western countries, the incidence of DVT was reported to be 34- 63% in patients after total hip arthroplasty (5) and 41-88% after total knee arthroplasty (6). The thromboprophylaxis is routinely used due to the high incidence of DVT and its harmful consequences. In contrast, thromboprophylaxis has rarely been used in major surgeries in Asian patients. The incidence of DVT has traditionally been considered to be low in Asian countries, presumably because of ethnic and environmental factors. There is a paucity of studies in Asia on post operative DVT. Hip replacement is associated with a 51% incidence of DVT in operated limbs according to Stamatakis (7). Knee replacement is confirmed to carry a high risk with ipsilateral DVT in 56.4% and symptomatic pulmonary embolism in 1.9% of the patients. By contrast, arthroscopy was associated with a low incidence of DVT. Meniscetomy, arthrotomy, patellotomy, synovectomy and arthrodesis were all high risk procedures, particularly in patients over 40 years of age and were associated with DVT rates of 25% to 67% (7). Recent studies from Asia have shown a higher incidence of DVT (10-64%) in patients after Total Hip Arthroplasty (THA) and 22.6 – 76.5% after Total Knee Arthroplasty (TKA) (8), (9). The increased incidence in the Asian population may be related to the increasing number of TKA procedures in this region and the influence of western dietary habits. Another reason for the increased incidence is the diagnostic criteria. In considering the main risk factors of DVT such as age, major surgery, prolonged immobility, malignancy, prior venous thromboembolism and oral contraception, Asian people have a similar risk as the westerners (10).
In the present study, some relationship was found between the main risk factors and DVT. No difference was found in the mean age and sex. There was some correlation with the type of anaesthesia, the time of anaesthesia, malignancy and prolonged immobility. The incidence of DVT in brain tumour patients has been reported to be high. Ruff and Posner (11) reported a 25% incidence of venogram proven DVT in a retrospective series of 264 unprophylaxed patients who were diagnosed to have glioblastoma multiforme or malignant astrocytoma, up to 6 weeks post craniotomy.

Our results suggest that the incidence of post operative DVT in our patients with brain tumour is lower than the rate that is reported in the populations of North America and Europe. However, the occurrence of DVT in neurosurgery patients is more as compared to that in patients of orthopaedics and general surgery. Age is uncertain as a risk factor. Borrow and Goldson (12) found an increasing incidence of thrombosis with greater age, but Stulberg et al (2) found no correlation. We found no age difference in the mean ages between the patients with and without DVT. In our study, 2/3 of patients who developed DVT were operated under general anaesthesia, thus showing a significant difference between general and spinal anaesthesia. However, it has been suggested that the incidence of DVT is lower after surgery under spinal anaesthesia as compared to that after surgery under general anaesthesia (13). We too found a statistically significant correlation between the type of operation and the incidence of DVT, with the highest incidence after craniotomy and the lowest incidence after abdominal surgeries. Patients with supratentorial tumours, suprasellar tumours, meningiomas and malignant glioma have been suggested to be at an increased risk (11). From our study, we found that the type of anaesthesia, the extent of surgery and post-operative stay alter the incidence of deep vein thrombosis. Patients with brain tumours are acknowledged to be in the high risk group (14).

In the present study, out of 14 cases of DVT, 4 patients had craniotomy, of which three had glioma and one had meningioma. Duplex ultrasonography is increasingly being used in combination with colour Doppler flow imaging and is accepted to be highly sensitive and specific for venous evaluation between the pelvis and the knees in patients with localizing signs and symptoms (5), (10). Ultrasonography is highly dependent on the operator’s skill and experience. In our study, we used Duplex as a definitive study, 14 out of 100 patients were found with DVT and 3 of the patients with leg swelling and calf tenderness showed normal duplex. The frequency found in our study was significantly less than that found in a similar study in the Malaysian population, where the comparable figure was 62.3% (15). The equivalent figures from Hong Kong and Singapore were 37% (16) and 3%(17) respectively and it was 4% in Thai patients (18). The figure here is quite low as compared to our study. In another study from South India, the incidence was found to be 28% (19), which was much higher than our series.

Agarwala and colleagues (20) conducted a prospective randomized study in 104 Indian patients undergoing major orthopaedic lower limb surgery, which has shown a 60% incidence of DVT in patients who did not receive prophylaxis and a 43.2% incidence in patients receiving prophylaxis with LMWH. Ishtiaq (21) conducted a Cohort study on patients of both genders over the age of 40 years and reported that out of 177 patients, post operative DVT was observed in 16 patients with the frequency of DVT after high risk surgery being 12.82%, which is lower than that cited in western literature. Chan, Chiu and Cheng (22) did a prospective study on the incidence of DVT in elderly Chinese people suffering from hip fracture. The study on a total of 100 consecutive Chinese hip fracture patients with a mean age of 80, showed that 5 (5.3%) of them developed DVT and it was concluded that the incidence of DVT in Chinese geriatric patients was low. In 1979, Mok (23) reported the incidence of DVT to be 53.3% in Hong Kong. In 1988-89, a few reports showed a very low incidence of DVT in Asian Countries, ie 10% in Korea, 9.7% in Singapore and 4% in Thailand (9), (24) and these results correspond to our results (14%). Some recent Asian clinical trials have shown a high incidence 15% - 70 % of DVT (8), (9), (16), (25).
Pearsall EA at al (26) concluded that many patients do not receive adequate thromboprophylaxis when they are admitted for acute abdominal conditions. Pedersen AB et al (27) have reported 1.02% of venous thromboembolism in patients undergoing total hip replacement in spite of receiving routine thromboprophylaxis. Kapoor A et al (28) have conducted a nationwide in-patient survey (2003-2006) and have recommended thromboprophylaxis for older patients. Fleming FJ ET AL (29) have reported 0.47% post discharge incidence of venous thrombosis in colorectal surgeries.

Limitations Of The Study
This study is from a single centre with a small sample size.

Conclusion

From this study, we conclude that the incidence of deep vein thrombosis in postoperative patients is 14% as compared to 34 – 63% among the Western population. Longer operating time, prolonged hospital stay and malignancy correlate with an increased incidence of DVT. If it occurs, diagnosis and treatment must be made as soon as possible, so that the fatal complications of pulmonary embolism can be avoided. There is a need to provide prophylactic anticoagulant therapy to those who have to undergo neurosurgery and major orthopaedic surgery, or to those who have risk factors. Many further extensive studies on Indian patients need to be undertaken.

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