title: Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy.
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.
authors.affiliation: Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kimmell
authors.forename: Babak S
authors.initials: BS
authors.lastname: Jahromi
mesh_terms: D003399:Craniotomy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology*
keywords: ACS = American College of Surgeons; ACS NSQIP; ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; CPT = current procedural terminology; DVT = deep venous thrombosis; MI = myocardial infarction; NSQIP = National Surgical Quality Improvement Program; OR = odds ratio; PE = pulmonary embolism; RCT = randomized controlled trial; SCIP = Surgical Care Improvement Project; TIA = transient ischemic attack; UTI = urinary tract infection; VTE = venous thromboembolism; craniotomy; diagnostic and operative techniques; outcomes; quality; venous thromboembolism