Venous thromboembolism rates and risk factors following endoscopic skull base surgery

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.