Venous thromboembolism rates and risk factors following endoscopic skull base surgery. Issue 7 (5th January 2022)

• Record Type: Journal Article
• Authors: Chang, Michael T.; Jitaroon, Kawinyarat; Song, Sunhee; Roozdar, Pooya; Wangworat, Yossawee; Ibrahim, Nour; Ma, Yifei; Rao, Vidya K.; Chang, Steven D.; Fernandez‐Miranda, Juan C.; Patel, Zara M.; Dodd, Robert L.; Hwang, Peter H.; Harsh, Griffith R.; Nayak, Jayakar V.
• Is Part Of: International forum of allergy & rhinology. Volume 12:Issue 7(2022)
• Page Start: 935
• Page End: 941
• Publication Date: 2022-01-05
• Subjects: skull base -- endoscopic skull base surgery -- postoperative -- pituitary adenoma venous thrombolism (VTE) deep vein thrombosis (DVT) pulmonary embolism (PE); 617.51005
• DOI: 10.1002/alr.22943
• Languages: English
• ISSNs: 2042-6976

Abstract

Abstract: Background: Venous thromboembolism (VTE) is a potentially fatal perioperative complication. The objective of this study was to assess the rate and risk factors for VTE in endoscopic skull base surgery (ESBS). Methods: This was a retrospective review of adults undergoing ESBS at a tertiary academic center. Incidence of VTE in the 30‐day postoperative period was recorded. Logistic regression analyses identified factors associated with VTE. Results: A total of 1122 ESBS cases performed at Stanford University School of Medicine between 2009 and 2019 were studied. Almost all cases (96.1%) did not employ perioperative VTE chemoprophylaxis. The overall incidence of VTE was 2.3% (26/1122). Malignant pathologies had a higher rate of VTE compared with nonmalignant pathologies (4.5% vs 2.0%, odds ratio [OR] 2.85, 95% confidence interval [CI] 1.22–6.66). Factors associated with an increased risk of VTE included a Caprini score greater than 5 (OR 1.53, 95% CI 1.28–1.83); multiple preoperative endocrinopathies such as the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (OR 22.48, 95% CI 3.93–128.70), adrenal insufficiency (OR 5.24, 95% CI 1.82–15.03), hypercortisolism (OR 4.46, 95% CI 1.47–13.56), and hypothyroidism (OR 3.69, 95% CI 1.66–8.20); each 10‐hour increment of lumbar drain duration (OR 1.16, 95% CI 1.08–1.25); and each 10‐hour increment for duration of hospitalization (OR 1.05, 95% CI 1.03–1.06). Conclusions: The incidence of VTE following ESBS is relatively low at 2.3%. Factors with a higher association of VTE include malignancy, preoperative endocrinopathies, higher Caprini score, prolonged lumbar drain duration, and prolonged hospitalization. Larger, multi‐institutional studies are needed to validate these findings and to better refine clinical decision‐making regarding perioperative VTE prophylaxis.