Risk factors for venous thromboembolism in patients undergoing craniotomy for neoplastic disease.

Abstract

Patients undergoing neurosurgical procedures for neoplasia have historically been considered at higher risk for developing venous thromboembolism (VTE). We sought to identify risk factors associated with VTE in patients undergoing craniotomy for tumor resection. We reviewed a national surgical quality database (American College of Surgeons National Surgical Quality Improvement Project, ACS-NSQIP, http://site.acsnsqip.org/ ). Patients undergoing non-emergent craniotomy for neoplastic indications were identified based on current procedural terminology codes. Clinical factors were identified that were associated with VTE events. 3,098 patients who underwent non-emergent craniotomy were identified. 1,741 patients underwent procedures for neoplastic disease (56.2%). The rate of DVT in these patients was 3.2% compared to 1.4% in other neurosurgical patients (OR 2.30, CI 2.29-2.30). The rate of pulmonary embolism was 1.8% compared to 0.5% (OR 3.61, CI 3.60-3.62). Univariate analysis identified several factors correlated with VTE. Pre-operative characteristics associated with VTE were the presence of impaired sensorium, dependent functional status, and age>60years. Total operative time>4h was associated with VTE. Post-operative events associated with VTE included pneumonia, unplanned intubation, fail to wean from ventilator, UTI, stroke, sepsis and septic shock. Age>60, OR time>4h, UTI, and septic shock were significantly associated with VTE in multivariate analysis. Patients undergoing craniotomy for neoplasm are at increased risk of VTE. This risk appears to be modified by pre-operative medical comorbidities, longer operative time, and post-operative complications.