Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy

Objectives Craniotomy poses a risk for postoperative venous thromboembolism (VTE), but the utility of anticoagulation in this patient population is unclear. We sought to identify risk factors predictive of VTE in patients undergoing craniotomy. Methods The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) database was reviewed for patients undergoing craniotomy. Clinical factors provided by the database were analyzed for association with VTE. Results A total of 10,477 adult patients who underwent craniotomy from 2011-2012 were identified. The rate of VTE was 3.2% (pulmonary embolism [PE] was 1.3%; deep vein thrombosis [DVT] was 2.4%). Several factors were significant in univariate analysis, and a subset persisted after multivariate analysis. Patients were assigned a risk score on the basis of the presence of those variables. Higher risk scores were predictive of VTE risk, as well as increasing time from surgery to discharge and mortality. A receiver operating characteristics curve revealed a significant area under the curve (0.719) for scores being predictive of VTE risk. The model was validated against our similar analysis of 2006-2010 NSQIP data and demonstrated comparable findings. Conclusions The risk of postoperative VTE after craniotomy can be quantified by a simple risk score, with increasing risk factors conferring increased risk of VTE. On the basis of risk scoring, a subset of patients who would benefit from anticoagulation post craniotomy may be identified.