title: Association of Steroid Use with Deep Venous Thrombosis and Pulmonary Embolism in Neurosurgical Patients: A National Database Analysis.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) is a major preventable cause of morbidity and mortality in hospitalized patients and is a widely accepted measure for quality of care. Prolonged corticosteroid therapy, which is common in neurosurgical patients, has been associated with VTE. Using a national database, we sought to determine whether corticosteroid use for >10 days was an independent risk factor for deep venous thrombosis (DVT) and pulmonary embolism (PE).
  
  
  METHODS
  The well-validated American College of Surgeons National Surgical Quality Improvement Program database was queried to evaluate the rates of VTE during the period 2006-2013 in patients undergoing neurosurgical procedures. A multivariate regression model was constructed to assess the effect of prolonged corticosteroid use on the occurrence of PE and DVT by postoperative day 30.
  
  
  RESULTS
  Of 94,620 patients identified, 565 (0.60%) developed PE and 1057 (1.12%) developed DVT within 30 days after surgery. In the multivariate model, patients receiving corticosteroids were significantly more likely to have PE (odds ratio = 1.47, 95% confidence interval = 1.13-1.90, P = 0.004) and DVT (odds ratio = 1.55, 95% confidence interval = 1.28-1.87, P < 0.001). Other factors independently associated with development of PE and DVT included the presence of malignancy, longer hospitalization, certain infections (including pneumonia and urinary tract infections), and stroke with a neurologic deficit.
  
  
  CONCLUSIONS
  In the neurosurgical population, prolonged courses of corticosteroids are associated with an increased risk of developing postoperative DVT and PE, even when controlling for potential confounders.
authors.affiliation: Cerebrovascular Laboratory, Columbia University, New York, New York, USA; Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; School of Medicine, New York University, New York, New York, USA. Electronic address: Elisha.lieber@gmail.com.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Lieber
authors.affiliation: Weill Cornell Medical College, Cornell University, New York, New York, USA.
authors.forename: James
authors.initials: J
authors.lastname: Han
authors.affiliation: Cerebrovascular Laboratory, Columbia University, New York, New York, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Appelboom
authors.affiliation: Cerebrovascular Laboratory, Columbia University, New York, New York, USA; College of Physicians and Surgeons, Columbia University, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA.
authors.forename: Blake E S
authors.initials: BE
authors.lastname: Taylor
authors.affiliation: School of Medicine, New York University, New York, New York, USA.
authors.forename: ByoungJun
authors.initials: B
authors.lastname: Han
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Cerebrovascular Laboratory, Columbia University, New York, New York, USA; Department of Neurosurgery, Columbia University, New York, New York, USA; Neuro-Intensive Care Unit, Columbia University Medical Center, New York, New York, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D014481:United States; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Corticosteroids; Deep vein thrombosis; National Surgical Quality Improvement Program; Pulmonary embolism