Preoperative Bleeding Risk Factors in Patients with Morbid Obesity Undergoing Anterior Skull Base Surgery

Objectives: The purpose of this study is to examine the relationship between preoperative bleeding risk in morbidly obese patients who underwent anterior skull base procedures and postoperative complication rates. We also examine the association between bleeding complication rate in morbidly obese patients who underwent anterior skull base procedures.

Study Design: Retrospective database review.

Methods: The 2005–2015 National Surgical Quality Improvement Program (NSQIP) database was used to identify patients with morbid obesity who underwent anterior skull base surgery. Propensity score matching (PSM) was conducted to homogenize the study population. Chi-squared analysis and logistic regression were used to determine the independent effect of covariates on postoperative complication rates.

Results: A total of 4,053 patients with known preoperative prothrombin time (PT), partial thromboplastin time (PTT), international normalized ratio (INR), and platelet levels who underwent anterior skull base surgery by neurosurgeons and otolaryngologists were identified. These patients were divided into two cohorts: morbidly obese (BMI ≥ 40 kg/m²; n = 318) and nonmorbidly obese (BMI < 40 kg/m²) (n = 3735). Univariate analysis of this cohort indicated a significant association between morbid obesity and increased values of preoperative PT (p = 0.049), PTT (p = 0.004), and platelet levels (p = 0.026), but not INR (p = 0.473). Additionally, the morbid obesity cohort had a significant difference for bleeding risk during the procedure (p = 0.036) compared with the non-morbid obesity group.

Conclusion: Patients undergoing anterior skull base surgery whose BMI ≥ 40 kg/m demonstrated a significantly greater bleeding risk during surgery (p = 0.036) compared with the nonmorbid obesity group. On univariate analysis, these patients demonstrated a statistically significant association between body mass index status and preoperative PT, PTT, and platelet levels.

Publication History

Article published online:
12 February 2021