• Bryan A Lieber, James Han, Geoffrey Appelboom, Blake E S Taylor, ByoungJun Han, Nitin Agarwal, and E Sander Connolly.
• Cerebrovascular Laboratory, Columbia University, New York, New York, USA; Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; School of Medicine, New York University, New York, New York, USA. Electronic address: Elisha.lieber@gmail.com.
• World Neurosurg. 2016 May 1; 89: 126-32.

ObjectiveVenous thromboembolism (VTE) is a major preventable cause of morbidity and mortality in hospitalized patients and is a widely accepted measure for quality of care. Prolonged corticosteroid therapy, which is common in neurosurgical patients, has been associated with VTE. Using a national database, we sought to determine whether corticosteroid use for >10 days was an independent risk factor for deep venous thrombosis (DVT) and pulmonary embolism (PE).MethodsThe well-validated American College of Surgeons National Surgical Quality Improvement Program database was queried to evaluate the rates of VTE during the period 2006-2013 in patients undergoing neurosurgical procedures. A multivariate regression model was constructed to assess the effect of prolonged corticosteroid use on the occurrence of PE and DVT by postoperative day 30.ResultsOf 94,620 patients identified, 565 (0.60%) developed PE and 1057 (1.12%) developed DVT within 30 days after surgery. In the multivariate model, patients receiving corticosteroids were significantly more likely to have PE (odds ratio = 1.47, 95% confidence interval = 1.13-1.90, P = 0.004) and DVT (odds ratio = 1.55, 95% confidence interval = 1.28-1.87, P < 0.001). Other factors independently associated with development of PE and DVT included the presence of malignancy, longer hospitalization, certain infections (including pneumonia and urinary tract infections), and stroke with a neurologic deficit.ConclusionsIn the neurosurgical population, prolonged courses of corticosteroids are associated with an increased risk of developing postoperative DVT and PE, even when controlling for potential confounders.Copyright © 2016 Elsevier Inc. All rights reserved.

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