Postoperative Venous Thromboembolism after Neurotologic Surgery

Objective: To determine the incidence of postoperative venous thromboembolism (VTE) in adults undergoing neurotologic surgery at a single center.

Methods: The records of adults undergoing neurotologic surgery from August 2009 to December 2016 at a tertiary care hospital were reviewed for VTE within 30 postoperative days. This included intradural as well as extradural intracranial lateral skull base procedures. Particular attention was focused on postoperative diagnosis codes, imaging, and a keyword search of postoperative notes. Caprini risk scores were calculated.

Results: Among 387 patients, 5 experienced postoperative VTE, including 3 cases of pulmonary embolism (PE), and two cases of isolated deep vein thrombosis (DVT). All patients were given sequential compression devices perioperatively, and none received preoperative chemoprophylaxis. All VTE events occurred within the first 9 days of surgery. Caprini scores were significantly higher in patients who developed VTE compared with patients who did not (5.8 vs. 4.11, p = 0.01). Those with Caprini score >8 had a significantly higher rate of VTE compared with those <8 (8 vs. 1%, p = 0.03). Receiver operating characteristic analysis revealed the Caprini risk assessment model to be a good predictor of VTE, with a C-statistic of 0.70 (95% CI: 0.49–0.92). Multiple regression analysis showed that prior stroke was significantly predictive of postoperative VTE (p = 0.03), while all other factors used to calculate the Caprini score, such as age, body mass index, or prior VTE, were not.

Conclusion: While no specific validated VTE risk stratification scheme has been widely accepted for patients undergoing neurotologic surgery, the Caprini score appears to be a useful predictor of risk. The benefits of chemoprophylaxis should be balanced with the risks of intraoperative bleeding and associated decreased visualization of critical skull base structures, as well as the potential for postoperative intracranial hemorrhage.

No conflict of interest has been declared by the author(s).