Skip to main content
  • Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy

    Final Number:

    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.

    References: 1. Camden, R.; Ludwig, S., Prophylaxis against venous thromboembolism in hospitalized medically ill patients: Update and practical approach. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2014, 71 (11), 909-17. 2. Hamilton, M. G.; Yee, W. H.; Hull, R. D.; Ghali, W. A., Venous thromboembolism prophylaxis in patients undergoing cranial neurosurgery: a systematic review and meta-analysis. Neurosurgery 2011, 68 (3), 571-81. 3. Goldhaber, S. Z.; Dunn, K.; Gerhard-Herman, M.; Park, J. K.; Black, P. M., Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis. Chest 2002, 122 (6), 1933-7. 4. Collen, J. F.; Jackson, J. L.; Shorr, A. F.; Moores, L. K., Prevention of venous thromboembolism in neurosurgery: a metaanalysis. Chest 2008, 134 (2), 237-49. 5. Kimmell, K. T.; Walter, K. A., Risk factors for venous thromboembolism in patients undergoing craniotomy for neoplastic disease. Journal of neuro-oncology 2014, 120 (3), 567-73. 6. Ingraham, A. M.; Richards, K. E.; Hall, B. L.; Ko, C. Y., Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Advances in surgery 2010, 44, 251-67. 7. Kimmell, K. T.; Jahromi, B. S., Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy. Journal of neurosurgery 2014, 1-8. 8. Orr, N. T.; Davenport, D. L.; Roth, J. S., Outcomes of simultaneous laparoscopic cholecystectomy and ventral hernia repair compared to that of laparoscopic cholecystectomy alone. Surgical endoscopy 2013, 27 (1), 67-73. 9. Moghadamyeghaneh, Z.; Hanna, M. H.; Carmichael, J. C.; Nguyen, N. T.; Stamos, M. J., A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2014, 18 (12), 2169-77. 10. Kester, B. S.; Merkow, R. P.; Ju, M. H.; Peabody, T. D.; Bentrem, D. J.; Ko, C. Y.; Bilimoria, K. Y., Effect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty. The Journal of bone and joint surgery. American volume 2014, 96 (17), 1476-84. 11. Grant, D. W.; Mlodinow, A.; Ver Halen, J. P.; Kim, J. Y., Catastrophic Outcomes in Free Tissue Transfer: A Six-Year Review of the NSQIP Database. Plastic surgery international 2014, 2014, 704206. 12. American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). User Guide for the 2012 ACS NSQIP Participant Use Data File. 13. Khaldi, A.; Helo, N.; Schneck, M. J.; Origitano, T. C., Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. Journal of neurosurgery 2011, 114 (1), 40-6. 14. Caprini, J. A.; Arcelus, J. I.; Hasty, J. H.; Tamhane, A. C.; Fabrega, F., Clinical assessment of venous thromboembolic risk in surgical patients. Seminars in thrombosis and hemostasis 1991, 17 Suppl 3, 304-12. 15. Cassidy, M. R.; Rosenkranz, P.; McAneny, D., Reducing postoperative venous thromboembolism complications with a standardized risk-stratified prophylaxis protocol and mobilization program. Journal of the American College of Surgeons 2014, 218 (6), 1095-104. 16. Aishima, K.; Yoshimoto, Y., Screening strategy using sequential serum D-dimer assay for the detection and prevention of venous thromboembolism after elective brain tumor surgery. British journal of neurosurgery 2013, 27 (3), 348-54. 17. Rolston, J. D.; Han, S. J.; Bloch, O.; Parsa, A. T., What clinical factors predict the incidence of deep venous thrombosis and pulmonary embolism in neurosurgical patients? Journal of neurosurgery 2014, 121 (4), 908-18.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy