Joeky Senders

59 Venous thromboembolism en intracranial hemorrhage months after surgery; however, no granular insight into the distribution of events within the first few weeks postoperatively was provided due to a low sample size. Neither did this study stratify for the type of VTE or clinical setting. Risk factors identified for VTE after craniotomy for gliomas are older age, history of craniotomy, history of VTE, coagulopathy, seizures, increased stay on the intensive care unit, prolonged hospital stay, residual tumor tissue, and absence of thromboprophylaxis. 3,4,6,12-15 Missios et al. stratified for VTE type demonstrating different risk profiles for postoperative DVT and PE. Male gender and Hispanic ethnicity were predictive for PE, whereas chronic heart failure was predictive for DVT. 3 Other predictors of postoperative VTE identified in the broader group of brain tumor patients were higher BMI, hypertension, functional dependence, lower Karnofsky Performance Scale (KPS) score, motor deficits, ventilator dependence, steroid usage, preoperative sepsis, longer operative times, and higher World Health Organization (WHO) tumor grade. 41,43,44,47,48 Prophylactic anticoagulation is a commonly used strategy to prevent VTE but should be carefully balanced against the risk of ICH. In previous studies, the rates of ICH following craniotomy for a brain tumor is cited as 1.0-4.0% with follow-up ranging between the initial hospital stay and long-term survival after surgery. 6,13-15,45,48-50 However, definitions for major ICH varied based on volumetric measurements of the hematoma, presence of symptoms, decrease in hemoglobin, or need for surgical evacuation. 14,15,22,24,25,51 Mantia et al. assessed the cumulative incidence of ICH over time after craniotomy for glioma. However, no time-to-event analysis was provided for the direct postoperative period due to a low sample size. 24 Neither did this study stratify for the clinical setting of the patient. Risk factors associated with ICH were history of craniotomy, use of bevacizumab, and therapeutic anticoagulation for VTE. 13,21-25 The association between thromboprophylactic anticoagulation and ICH remains to be elucidated. 15 To our knowledge, the current study is the first large multicenter assessment including a descriptive time-to-event analysis for both VTE and ICH within 30 days after craniotomy for a primary malignant brain tumor. Additionally, it is the first study that uses the NSQIP database to identify predictors of ICH after brain tumor resection. By addressing thrombotic outcomes as well as hemorrhagic outcomes, this study provides a meaningful direction for future research on thromboprophylactic treatment strategies. Lastly, the large sample size allows a stratification of both the descriptive and inferential analyses, demonstrating differences in risk profile and incidence over time based on VTE type and clinical setting.