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  • Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy

    Final Number:
    1146

    Authors:
    Hanna Algattas; Kristopher T. Kimmell MD; G. Edward Vates MD, PhD; Babak S. Jahromi MD, PhD, FRCS(C)

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Craniotomy poses a risk for post-operative venous thromboembolism (VTE) but the utility of anticoagulation in this patient population is unclear. We sought to identify risk factors predictive of VTE in patients undergoing craniotomy.

    Methods: A national surgical quality database (American College of Surgeons National Surgical Quality Improvement Project, ACS-NSQIP) was reviewed for patients undergoing craniotomy based on current procedural terminology (CPT) code. Clinical factors provided by the database were analyzed for association with VTE.

    Results: A total of 10,477 adult patients who underwent craniotomy from 2011-2012 were identified. The rate of VTE was 3.2% (pulmonary embolism (PE) was 1.3%; deep vein thrombosis (DVT) was 2.4%). Several factors were identified as significant in univariate analysis and a subset of these persisted after multivariate analysis (pre-operative ventilator status, non-elective surgery, BMI, time from admission to operation, age, race, chronic steroid use, inpatient status, impaired sensorium, ASA score, post-operative infection, returning to the operating room, and post-operative ventilator span). Patients were assigned a risk score based on the presence of variables identified from multivariate analysis. Higher risk scores were predictive of VTE risk as well as increasing time from surgery to discharge and mortality. A receiver operating characteristics curve revealed a significant area under the curve of 0.719 for scores being predictive of VTE risk. The model was validated against our similar analysis of 2006-2010 NSQIP data and demonstrated comparable findings.

    Conclusions: The risk of post-op VTE after craniotomy is influenced by pre-operative comorbidities and post-operative complications. This risk can be quantified by a simple risk score, with increasing risk factors conferring increased risk of VTE. Based on risk scoring a subset of patients may be identified that would benefit from anticoagulation post-craniotomy.

    Patient Care: Identify risk factors for development of VTE in patients undergoing craniotomy.

    Learning Objectives: 1) Understand the factors associated with VTE post-craniotomy. 2) Develop a risk scoring system which is capable of delineating a subset of patients at highest risk for VTE. 3) Demonstrate the effectiveness of the VTE risk scoring model against previously analyzed data.

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