Introduction: Patients undergoing neurosurgery are at risk for venous thromboembolism (VTE). Preventive medical therapies reduce incidence of deep vein thrombosis (DVT) and pulmonary emboli (PE), but may increase risk for bleeding. Understanding the prevalence of VTE and its predictors are imperative for better identifying those who may benefit from preventive therapeutic intervention. This study utilizes data from the National Surgical Quality Improvement Program (NSQIP) between 2005 and 2014 to estimate the prevalence and predictors of VTE in neurosurgical cases.
Methods: Data on 3,723,797 patients during 2005-2014 were obtained from the NSQIP database. Neurosurgical cases were selected from surgical specialty of ‘neurosurgery’. Cases were classified as spine or cranial using current procedural terminology (CPT) codes. VTE was defined as presence of DVT or PE. Descriptive statistics for demographic and preoperative variables were estimated. Univariate analysis was performed for VTE, DVT, and PE. Backward stepwise (p<0.05) multivariate logistic regression was performed to predict VTE, DVT, and PE using significant predictors from univariate analysis.
Results: A total of 132,063 neurosurgical cases (97,907 spine, 30,497 cranial) were identified. Overall, there were 1,922 (1.46%) cases of VTE with 952 (0.97%) and 944 (3.1%) for spine and cranial cases, respectively. Predictors of VTE included: age, height, weight, race, smoking, recent weight loss, diabetes, ventilator dependence, hemiplegia, paraplegia, quadriplegia, brain tumor, stroke, impaired sensorium, coma, COPD, CHF, PVD, PCI, esophageal varices, metastatic cancer, chronic steroid use, wound infection, transfusion, and sepsis. These predictors varied by type of surgery (overall, spine, cranial) and outcome of interest (VTE, DVT, PE).
Conclusions: VTE affects 1.46% of neurosurgical cases with roughly three times higher prevalence in cranial over spine cases. A variety of factors predict VTE, DVT, and PE. These predictors varied by surgery type and outcome of interest. This suggests different pre-operative predictors may uniquely identify patients at risk for VTE, DVT, and PE.
Patient Care: This study provides estimates of the prevalence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) in neurosurgery overall and stratified by spine and cranial surgery. Our findings highlight significant predictors for these postoperative outcomes distinguished by the type of surgery. When applied to clinical scenarios, this research may assist in identifying those at greater risk for VTE, DVT, and PE who may benefit from prophylactic interventions.
Learning Objectives: By the end of the session, participants will be able to: 1) Provide estimates of the prevalence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and pulmonary embolism (PE) following neurosurgery; 2) Describe independent predictors for VTE, DVT, and PE across spine and cranial surgery; 3) Identify significant predictors for VTE, DVT, and PE from multivariate analysis for spine and cranial surgery.