Prevalence and risk factors of postoperative venous thromboembolism in Cushing’s disease and establishment of a risk assessment model

Abstract Purpose: The incidence of venous thromboembolism (VTE) in Cushing’s disease (CD) is about ten times higher than that in general population, which tends to be underestimated due to the missed detection of asymptomatic VTE events. VTE can occur at any stage of CD, mainly during the postoperative period. We aim to investigate the incidence and prothrombotic risk factors of postoperative VTE in CD patients and to further develop an assessment model to identify those at high risk of postoperative VTE events. Methods: We performed a retrospective study in 82 CD patients by evaluating their clinical, hormonal, and coagulation parameters, as well as ultrasonography and pulmonary angio-CT when necessary. Results: Nineteen patients (23.2%) developed VTE events, of which 14 developed VTE after endoscopic transsphenoidal surgery (ETS). The group of CD patients with postoperative VTE were elder (p<0.001), had more infection (p<0.05) and reduced mobility (p<0.05), higher HbA1c, and more severe impairment of glucose tolerance than those without. By using stepwise regression analysis, we obtained 4 independent risk factors for postoperative VTE: age, 2-h insulin in OGTT, current infection, and postoperative bedtime. Then a VTE risk assessment nomogram model was established to predict the patients at high risk of VTE. In this nomogram model, 70 patients (85.7%) were classified correctly, and area under the curve was 0.899 (95%CI, 0.787-0.999). Conclusion: Advanced perioperative assessment needs to be taken to screen those with high VTE risks in CD patients. Moreover, physical movement and antithrombotic prophylaxis seems to be warranted during perioperative period.