Introduction: Venous thromboembolism (VTE) is a major preventable cause of morbidity and mortality in hospitalized patients, and is a widely accepted indicator of quality of care. Patients undergoing neurosurgery are at high risk of VTE due to prolonged bed rest and frequent contraindications to VTE prophylaxis with anticoagulants. Recently, prolonged corticosteroid therapy—common in this population—has been associated with VTE. Using a national database, we sought to determine whether corticosteroid use >10 days is an independent risk factor for VTE.

Methods: The well-validated American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to evaluate the rates of VTE between 2006 and 2013 in patients undergoing neurosurgical procedures. After a univariate analysis (Table 1), a multivariate regression model was constructed to assess the effect of prolonged corticosteroid use on the occurrence of pulmonary embolism (PE) (Table 2) and deep venous thrombosis (DVT) (Table 3) by postoperative day 30.

Results: Of 94,620 patients identified, 565 (0.60%) developed PE and 1,057 (1.12%) developed DVT within 30 days after surgery. In the multivariate models (Tables 2-3), patients on corticosteroids were significantly more likely to have PE [OR: 1.47 (95% CI 1.13-1.90); p=0.004) and DVT [OR: 1.55 (1.28-1.87); p<0.001]. Other factors independently associated with development of PE and DVT included presence of malignancy, longer hospitalization, certain infections (including pneumonia and urinary tract infections), and stroke with a neurological deficit.

Conclusions: Among 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.

Patient Care: The goals of our study are to raise awareness about and to provide data on the risk of venous thromboembolism (VTE) in neurosurgery patients on corticosteroids (eg. those undergoing surgery for brain tumors). Patient care may benefit from a greater ability to weigh the risks and benefits of providing effective VTE prophylaxis.

Learning Objectives: By the conclusion of this session, the key messages to participants are: 1) Our results suggest that prolonged use of corticosteroids increases the risk of VTE, as has been suggested in other specialties 2) Future studies should seek to weigh the benefit of VTE prophylaxis (ie. anticoagulation) with the risk of intracranial hemorrhage

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