Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy

Kristopher T. Kimmell*, Babak S. Jahromi

*Corresponding author for this work

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

OBJECT Patients undergoing craniotomy are at risk for developing venous thromboembolism (VTE). The safety of anticoagulation in these patients is not clear. The authors sought to identify risk factors predictive of VTE in patients undergoing craniotomy. METHODS The authors reviewed a national surgical quality database, the American College of Surgeons National Surgical Quality Improvement Program. Craniotomy patients were identified by current procedural terminology code. Clinical factors were analyzed to identify associations with VTE. RESULTS Four thousand eight hundred forty-four adult patients who underwent craniotomy were identified. The rate of VTE in the cohort was 3.5%, including pulmonary embolism in 1.4% and deep venous thrombosis in 2.6%. A number of factors were found to be statistically significant in multivariate binary logistic regression analysis, including craniotomy for tumor, transfer from acute care hospital, age ≥ 60 years, dependent functional status, tumor involving the CNS, sepsis, emergency surgery, surgery time ≥ 4 hours, postoperative urinary tract infection, postoperative pneumonia, on ventilator ≥ 48 hours postoperatively, and return to the operating room. Patients were assigned a score based on how many of these factors they had (minimum score 0, maximum score 12). Increasing score was predictive of increased VTE incidence, as well as risk of mortality, and time from surgery to discharge. CONCLUSIONS Patients undergoing craniotomy are at low risk of developing VTE, but this risk is increased by preoperative medical comorbidities and postoperative complications. The presence of more of these clinical factors is associated with progressively increased VTE risk; patients possessing a VTE Risk Score of ≥ 5 had a greater than 20-fold increased risk of VTE compared with patients with a VTE score of 0.

Original languageEnglish (US)
Pages (from-to)1004-1011
Number of pages8
JournalJournal of neurosurgery
Volume122
Issue number5
DOIs
Publication statusPublished - May 2015

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Keywords

  • ACS NSQIP
  • Craniotomy
  • Diagnostic and operative techniques
  • Outcomes
  • Quality
  • Venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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