2026 Poster Presentations
P026: RATES AND RISK FACTORS FOR VENOUS THROMBOEMBOLISM AND BLEEDING IN ENDONASAL SKULL BASE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Chase Kahn, MD; Tyler Weber, BA; Mark Liu, MD; Lekha Medarametla, BS; Mary Pat Harnegie, MLIS; Matthew J Kabalan, MD; Troy D Woodard, MD; Raj Sindwani, MD; Varun R Kshettry, MD; Pablo F Recinos, MD; Christopher R Roxbury, MD, MBA; Cleveland Clinic Foundation
Objective: To quantify venous thromboembolism (VTE), deep venous thrombosis (DVT), pulmonary embolism (PE), and bleeding complications after endonasal skull base surgery and to explore variability across studies and surgical approaches.
Data Sources: Medline, Embase, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL).
Review Methods: Four reviewers searched five databases for English-language cohort or case-control studies of anterior skull base surgery. Studies were excluded for noneligible comparisons, interventions, populations or incomplete complication reporting.
Results: The search identified 1,360 studies. After removing duplicates, 925 titles/abstracts were screened, with 765 excluded. One hundred sixty full-text articles were assessed, and 108 studies (25,462 patients) were included. Pooled random-effects incidence of VTE was 1.35% (95% CI 1.07–1.71%; prediction interval 0.28–6.20%). Component rates were 0.99% for DVT (95% CI 0.79–1.24%; PI 0.35–2.79%) and 1.06% for PE (95% CI 0.84–1.33%; PI 0.30–3.63%). Overall bleeding occurred in 2.16% (95% CI 1.76–2.66%; PI 0.47–9.47%). VTE rates were highest in Cushing’s disease (3.80%, 95% CI 3.01–4.79%) and malignancy (4.54%, 95% CI 2.86–7.13%). Expanded approaches generally showed higher complication rates than standard approaches, consistent with greater case complexity.
Conclusion: Endonasal skull base surgery is associated with low mean rates of VTE and bleeding, but between-study heterogeneity is considerable. Prediction intervals indicate that event rates may exceed pooled means in some settings, supporting individualized prophylaxis, particularly for higher-risk pathologies and when using expanded approaches.