Joeky Senders

50 Chapter 3 The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database tracks outcomes of neurosurgical patients for 30 days postoperatively, including the occurrence of DVT, PE, and ICH. Because the risk of ICH is intimately tied to the thromboprophylactic strategy used in patients with a brain tumor, this study addresses thrombotic as well as hemorrhagic complications. In this study, NSQIP was used to identify predictors and perform descriptive time-to-event analyses for VTE and ICH. Assessment of VTE was stratified for VTE type (DVT versus PE) and clinical setting (during hospitalization versus after discharge). Methods Data source The NSQIP includes surgical patients from over 600 participating hospitals in the U.S. operated on from 2005 to 2015. This validated dataset is collected by trained surgical reviewers using a standardized protocol, and includes common postoperative complications, occurrence of reoperations and readmissions, together with associated reasons and time-to-event in days. The NSQIP registry has previously been used to study outcomes after neurosurgical procedures. 26-37 Our institutional review board has exempted the NSQIP database from review. Inclusion criteria Patients were included who met the following criteria: 1) age 18 years or older; 2) a Current Procedural Terminology (CPT) code indicating craniotomy for surgical resection of a brain tumor (CPT: 61500, 61510, 61512, 61518, 61519, 61520, 61521, 61526, and 61530); 3) a postoperative diagnosis indicative of a primary malignant brain tumor (International Classification of Diseases, Ninth Revision [ICD-9]: 191.x). Covariates Age, body mass index (BMI), and operative time were assessed continuously in years, kg/m 2 , and minutes, respectively. Other categorized pre- and perioperative covariates included sex, race, American Society of Anesthesiologists (ASA)-classification (I-II, III or IV-V), functional status (dependent or independent), smoking within one year prior to surgery, history of hypertension requiring medication, chronic heart failure, COPD, renal failure, dialysis, insulin dependent diabetes, bleeding disorder, weight loss (>10% loss of body weight in the six months prior to surgery), dyspnea, ventilator dependence, steroid usage, emergency classification, transfer status (admitted from home versus elsewhere), creatinine (<1.4 mg/dL vs. ≥1.4 mg/dL), hematocrit (<36% vs.