Short-Term Bed Rest is not a Risk Factor for Venous Thromboembolism After Endoscopic Skull Base Surgery

Eric H Abello; Joel S Feier; Arash Abiri; Jonathan C Pang; Lauren Liu; Cecilia H H Nguyen; Dean D Chung; Frank P K Hsu; Edward C Kuan

doi:10.1016/j.wneu.2024.09.129

Short-Term Bed Rest is not a Risk Factor for Venous Thromboembolism After Endoscopic Skull Base Surgery

World Neurosurg. 2024 Dec:192:e454-e459. doi: 10.1016/j.wneu.2024.09.129. Epub 2024 Oct 24.

Authors

Eric H Abello¹, Joel S Feier¹, Arash Abiri¹, Jonathan C Pang¹, Lauren Liu¹, Cecilia H H Nguyen¹, Dean D Chung¹, Frank P K Hsu², Edward C Kuan³

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA.
² Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA.
³ Department of Otolaryngology - Head and Neck Surgery, University of California Irvine Medical Center, Orange, California, USA; Department of Neurological Surgery, University of California Irvine Medical Center, Orange, California, USA. Electronic address: [email protected].

PMID: 39389462
DOI: 10.1016/j.wneu.2024.09.129

Abstract

Background: Venous thromboembolism (VTE) increases morbidity in postoperative patients. No current guidelines identify which patients undergoing endoscopic endonasal approach (EEA) to the skull base may be at increased risk. Postoperative care for these patients often includes a period of inactivity to prevent transient intracranial pressure shifts that may impact skull base reconstruction. We sought to characterize if postoperative bed rest puts patients undergoing EEA at increased risk of developing thromboembolic complications.

Methods: Retrospective chart review of patients undergoing intradural surgery with primary skull base reconstruction for intraoperative cerebrospinal fluid leak via EEA for any skull base pathology between July 2018 and May 2024 yielded 221 patients who met inclusion criteria. Univariate and multivariable regressions were performed with patient demographics, extent of approach, intraoperative leak flow rate, bed rest duration, presence and length of postoperative lumbar drainage, and use of postoperative mechanical VTE prophylaxis.

Results: Mean age of included patients was 52.6 ± 16.8 years, 48% of patients were male, and 3.6% of patients had DVTs. Age (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.96-1.06, P = 0.83), sex (OR 0.40, 95% CI 0.05-2.19, P = 0.31), body mass index (OR 0.98, 95% CI 0.87-1.07, P = 0.74), extended approach (OR 0.80, 95% CI 0.13-4.36, P = 0.80), cerebrospinal fluid leak flow rate (OR 5.71, 95% CI 0.77-118.90, P = 0.14), bed rest duration (OR 1.06, 95% CI 0.77-1.27, P = 0.60), and presence of lumbar drainage (OR 1.10, 95% CI 0.55-2.02, P = 0.76) were not significant predictors of postoperative VTE incidence on multivariable analysis.

Conclusions: Short-term bed rest after EEA is not a risk factor for development of VTE in the immediate postoperative period.

Keywords: Bed rest; Cerebrospinal fluid leak; Deep venous thrombosis; Endonasal; Endoscopic approach; Immobilization; Pituitary; Pulmonary embolism; Transsphenoidal; Venous thromboembolism.

MeSH terms

Adult
Aged
Bed Rest*
Cerebrospinal Fluid Leak / epidemiology
Cerebrospinal Fluid Leak / etiology
Female
Humans
Male
Middle Aged
Neuroendoscopy / adverse effects
Neuroendoscopy / methods
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Postoperative Complications* / prevention & control
Retrospective Studies
Risk Factors
Skull Base* / surgery
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology
Venous Thromboembolism* / prevention & control