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Semin Thromb Hemost 2016; 42(08): 870-876
DOI: 10.1055/s-0036-1592306
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Thromboembolism in Patients Undergoing Craniotomy for Brain Tumors: A U.S. Nationwide Analysis

David J. Cote
1   Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Heloise M. Dubois
1   Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Aditya V. Karhade
1   Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Timothy R. Smith
1   Department of Neurosurgery, Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
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Publication History

Publication Date:
20 October 2016 (online)

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Abstract

Background Patients who undergo craniotomy for brain tumor have an increased risk of developing venous thromboembolism (VTE). Using the National Surgical Quality Improvement Program (NSQIP) registry, patients undergoing craniotomy for brain tumor from 2006 and 2014 were analyzed to identify risk factors for postoperative VTE.

Methods The study population, identified by Current Procedural Terminology codes, included all NSQIP-reported patients who underwent a craniotomy for brain tumor resection.

Results There were 629 instances of VTE among 19,409 craniotomies for brain tumor (3.2%) recorded in NSQIP. Occurrence of VTE was associated with other postoperative complications on univariate analysis, including pneumonia, respiratory failure, stroke, and sepsis (all p < 0.001). On multivariate analysis, independent predictors of VTE included age 46 to 57 years (odds ratio [OR], 1.432; p = 0.006), 57 to 66 years (OR, 1.550; p = 0.001), or over 66 years (OR, 2.493; p < 0.001), body mass index (BMI) over 32.1 kg/m2 (OR, 1.835; p < 0.001), functional dependence (OR, 1.657; p < 0.001), ventilator dependence (OR, 2.516; p < 0.001), steroid use (OR, 1.661; p < 0.001), prior sepsis (OR, 1.845; p < 0.001), and total operative time 183 to 271 minutes (OR, 1.462; p = 0.032) and longer than 271 minutes (OR, 1.945; p < 0.001).

Conclusions VTE occurs in approximately 3% of patients undergoing craniotomy for brain tumor resection. Independent predictors for developing VTE include older age, higher BMI, recent steroid use, and total operative time.

Keywords

neurosurgery - venous thromboembolismcraniotomy - risk factors - complications - National Surgical Quality Improvement Program