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.
