Introduction: Venous-thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and mortality in patients undergoing craniotomy for primary malignant brain tumors. The National Surgical Quality Improvement Program (NSQIP) tracks surgical patients for 30 days postoperatively. This national registry was used to identify predictors of VTE and perform a descriptive analysis on the incidence of VTE over time and its relative contribution to morbidity.
Methods: Patients who underwent a craniotomy for a primary malignant brain tumor were extracted from the NSQIP registry (2006-2015). Predictors of VTE were identified by means of multivariable logistic regression.
Results: 7376 patients were identified of which 257 (3.5%) developed VTE, including DVT (2.6%) and PE (1.5%). DVT occurred at a median of 13 days after surgery, of which 39.6% occurred within the initial hospital stay. PE occurred at a median of 17 days after surgery, of which 27.1% were within the initial hospital stay (Figure 1). VTE was found to be the second-most common major complication after reoperation, and the third-most common reason for readmission (7.4%), after wound related complications and seizures. Multivariable analysis identified older age (p<.001), higher body mass index (BMI)(p<.001), longer operative times (p<.001), dependent functional status (p=.002), pre-operative white blood cell count above 12,000 cells/mm3 (p=.011), and steroid usage (p=.049) as predictors.
Conclusions: VTE is the second-most common major complication after craniotomy for primary malignant brain tumors. The increased risk of VTE extends beyond the period of hospitalization, resulting in VTE as one of the major reasons of readmission. In this multicenter study, older age, higher BMI, and longer operative times were identified as predictors of postoperative VTE.
Patient Care: This study provides an understanding of the major drivers of venous-thromboembolism in patients who underwent craniotomy for a primary brain malignancy. This could help identifying high-risk patients and tailor postoperative management to their individual risk profile.
Learning Objectives: By the conclusion of this session, participants should:
1) have knowledge of VTE as one of the major drivers of morbidity and readmission in patients who underwent a craniotomy for primary brain malignancy
2) understand that the risk of VTE extends beyond the period of hospitalization, especially for pulmonary embolism.
3) be familiar with the predictors or VTE