Venous Thromboembolism Risk and Outcomes Following Decompressive Craniectomy in Severe Traumatic Brain Injury: An Analysis of the Nationwide Inpatient Sample Database

Ali Basil Ali; Ayaz M Khawaja; Aoife Reilly; Zabreen Tahir; Shyam S Rao; Joshua D Bernstock; Patrick Chen; Janine Molino; William Gormley; Saef Izzy

doi:10.1016/j.wneu.2022.02.069

Venous Thromboembolism Risk and Outcomes Following Decompressive Craniectomy in Severe Traumatic Brain Injury: An Analysis of the Nationwide Inpatient Sample Database

World Neurosurg. 2022 May:161:e531-e545. doi: 10.1016/j.wneu.2022.02.069. Epub 2022 Feb 20.

Authors

Affiliations

¹ Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; The Royal College of Surgeons in Ireland, Dublin, Ireland.
² Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Wayne State University, Detroit, Michigan, USA.
³ Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
⁵ Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Department of Orthopedics, Brown University, Providence, Rhode Island, USA.
⁷ Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: sizzy@bwh.harvard.edu.

PMID: 35196589
DOI: 10.1016/j.wneu.2022.02.069

Abstract

Objective: Traumatic brain injury (TBI) is a risk factor for venous thromboembolism (VTE). The risk of VTE after decompressive craniectomy (DC) and its effects on the outcomes are unknown. We assessed the incidence of VTE, associated risk factors, and effects on the outcomes.

Methods: Using the National Inpatient Sample database, the hospitalizations of patients aged ≥18 years with a severe TBI diagnosis from 2004 to 2014 were extracted. The outcome was discharge status without mortality. Multivariable logistic and linear regressions were used.

Results: Of the 349,165 TBI hospitalizations, 23,813 (6.82%) had undergone DC and 14,175 (4.06%) had developed VTE. The VTE incidence was higher after DC compared with no DC (6.14% vs. 3.91%; P < 0.0001). DC (odds ratio [OR], 1.29; P < 0.005) was an independent predictor for the development of VTE. Age (OR, 1.26; P < 0.005), chronic lung disease (OR, 1.58; P < 0.05), electrolyte imbalance (OR, 1.43; P < 0.05), liver disease (OR, 0.10; P < 0.05), urinary tract infection (OR, 1.56; P < 0.05), pneumonia (OR, 2.03; P < 0.0001), and sepsis (OR, 1.57; P < 0.05) were significantly associated with the development of VTE. Obesity (OR, 2.09; P > 0.05) and spine injury (OR, 2.03; P > 0.05) showed a trend toward significance. VTE was associated with worse discharge outcomes (OR, 1.40; P < 0.05), longer lengths of stay (OR, 1.01; P < 0.00001), and higher costs (P < 0.0001).

Conclusions: Our study showed an independent association between DC and an increased risk of VTE for patients with severe TBI. The development of VTE after DC increased the proportion of poor outcomes, prolonged the length of stay, and increased the hospitalization costs. Older patients with obesity, an electrolyte imbalance, chronic lung disease, spine injury, and infections were at a greater risk of VTE after DC. These risk factors could help in considering VTE prophylaxis for these patients.

Keywords: Decompressive craniectomy; Deep vein thrombosis; Pulmonary embolism; Traumatic brain injury; Venous thromboembolism.

MeSH terms

Adolescent
Adult
Brain Injuries, Traumatic* / complications
Brain Injuries, Traumatic* / epidemiology
Brain Injuries, Traumatic* / surgery
Decompressive Craniectomy*
Electrolytes
Humans
Inpatients
Lung Diseases*
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology
Water-Electrolyte Imbalance*

Substances

Electrolytes