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

Abstract

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. The study population, identified by Current Procedural Terminology codes, included all NSQIP-reported patients who underwent a craniotomy for brain tumor resection. 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 < 0.001). On multivariate analysis, independent predictors of VTE included age 46 to 57 years (odds ratio [OR], 1.432; = 0.006), 57 to 66 years (OR, 1.550; = 0.001), or over 66 years (OR, 2.493; < 0.001), body mass index (BMI) over 32.1 kg/m (OR, 1.835; < 0.001), functional dependence (OR, 1.657; < 0.001), ventilator dependence (OR, 2.516; < 0.001), steroid use (OR, 1.661; < 0.001), prior sepsis (OR, 1.845; < 0.001), and total operative time 183 to 271 minutes (OR, 1.462; = 0.032) and longer than 271 minutes (OR, 1.945; < 0.001). 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.

Perioperative anticoagulation in patients with intracranial meningioma: No increased risk of intracranial hemorrhage?

“…Relevant indications (e.g. aortic valve replacement, atrial fibrillation, stents), risk factors for TE (immobilization, prolonged duration of surgery, prone position during surgery, coagulopathy, malignant diseases, infection, comorbidities, history of TE, old age, hemiparesis or hemiplegia) [2,3,[6][7][8][9][10][11][12] are weighed against risk factors for PH (intraoperative bleeding tendency, size and vascularization of the tumor, entity, prolonged operative time, metabolic syndrome). The variety of risk factors and intra-individual differences regarding tumor morphology, AC, and corresponding indication is vast [1,2,[6][7][8]13].…”

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

“…Several multicenter studies have previously investigated the short-term incidence of and risk factors for VTE after brain tumor surgery [ 3 , 13 , 39 – 45 ], of which four studies focused on glioma patients [ 3 , 13 , 39 , 41 ]. From these studies, the rate of VTE following craniotomy is cited as 3.3–7.5% for glioma patients [ 3 , 13 , 39 , 41 ] and 2.3–4.0% for brain tumors patients in general [ 11 , 40 – 42 , 44 ], with a follow-up ranging from solely the initial hospital stay to 6 weeks after surgery. The 30-day VTE rate was as high as 9.3% when asymptomatic DVTs were included too [ 3 ].…”

“…Male gender, Hispanic ethnicity, and medium bed size were predictive for PE, whereas chronic heart failure was predictive for DVT [ 3 ]. Other predictors of postoperative VTE identified in the broader group of brain tumor patients were higher BMI, hypertension, functional dependence, lower Karnofsky Performance Scale (KPS) score, motor deficits, ventilator dependence, steroid usage, preoperative sepsis, longer operative times, and higher World Health Organization (WHO) tumor grade [ 11 , 40 , 42 , 43 , 46 ].…”

“…A lack of scientific evidence is primarily the cause of this variation in recommendations. Recent systematic reviews and meta-analyses of VTE prophylaxis in patients undergoing craniotomy for brain tumors have been performed [ 42 , 57 – 60 ]. These analyses have compared different VTE prophylaxis modalities, as well as their safety and cost effectiveness, but they do not thoroughly investigate the efficacy of prophylaxis over time to determine a recommended duration.…”

Thromboembolic complications in neurosurgery: solutions at the boundaries of possible and necessary (review)

“…В эти исследования включено внушительное число нейрохирургических больных -от 7 376 до 32 695. При этом частота развития ВТЭО варьирует от 1,1 до 3,5 % [16][17][18][19]. Однако необходимо отметить, что в NSQIP регистрируются те случаи венозного тромбоза, который развился в течение 30 дней после первичного хирургического вмешательства, подтвержден по данным ультразвукового исследования (УЗИ), венографии, компьютерной томографии (КТ) или любого другого исследования, в том числе аутопсии, а также потребовал назначения антикоагулянтной терапии или имплантации кавафильтра.…”