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14-07-2011 | Surgery | Article

Ventriculostomy bleeding complications quantified

Abstract

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MedWire News: About 7% of ventriculostomy placements result in bleeding complications, show meta-analysis findings.

Significant hemorrhage occurs in about 0.8% of placements, according to James Market (University of Alabama, Birmingham, USA) and colleagues.

"Often it is difficult to quantify risks for patients because of the lack of high-quality, meaningful studies in the literature," they write in the journal Neurosurgery.

They add: "A rigorous meta-analysis of the risk of hemorrhage from a very common procedure, ventriculostomy placement, provides important data for neurosurgeons communicating with patients and their families about the risks of this procedure."

The researchers' meta-analysis included 16 studies, which provided data on 2428 ventriculostomy procedures. They included only studies in which a neurosurgeon performed the ventriculostomies, and excluded a study that exclusively looked at premature babies, noting that "the high rate of bleeding seen might be attributed to the immaturity of the brain parenchyma."

There has been one previous meta-analysis of hemorrhagic complications associated with ventriculostomy placement. This provided a simple average rate from all included studies, but Market et al say: "We think that a weighted average, as we performed in our study, is a more rigorous and meaningful approach.

"Performing calculations without giving any significance to the relative weight of each study can skew the analysis so that it is overly influenced by each study's sample size."

Using the weighted-average approach, the team found an overall hemorrhage rate of 7.0% and a significant hemorrhage rate of 0.8%.

Market and team also graded the studies in their analysis according to whether or not patients underwent routine postoperative computed tomography (CT) scans and the extent of hemorrhage was reported.

They stress that the rates of hemorrhage and significant hemorrhage in the highest grades of study, in which all patients underwent CT, were 12.1% and 1.4%, respectively.

These rates were higher than those in lower-graded studies, at 1.4% and 0.5%, respectively.

"It is likely that both minor and significant hemorrhages were missed in this second group of patients because of the lack of routine postprocedure CT imaging," say the researchers.

"The initial group of studies may represent a more accurate representation of the true rates of hemorrhage."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid

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