Abstract
Background
Deep vein thrombosis (DVT), a major component of venous thromboembolism (VTE), is a common postoperative complication. Its occurrence after pituitary adenoma surgery is influenced by multiple factors.
Methods
This retrospective study analyzed 1440 pituitary adenoma cases treated at Beijing Tiantan Hospital (2018–2023). The incidence of postoperative DVT was recorded, and logistic regression was used to identify associated risk factors. Differences across pituitary adenoma subtypes were compared. Additionally, Regression and machine learning models were developed to predict DVT.
Results
Among 397 patients who underwent postoperative lower limb ultrasound, 104 (7.2 %) developed DVT. Significant risk factors included advanced age, higher body mass index (BMI), intravenous cannulation, prolonged hospital stay, shorter preoperative activated partial thromboplastin time (APTT), longer thrombin time (TT), elevated platelet count, and higher postoperative D-dimer levels. Patients with Cushing’s disease exhibited a significantly higher DVT incidence, potentially related to decreased pre- and postoperative APTT and PT/INR values. Conversely, patients with prolactin-secreting adenomas had a lower DVT incidence, possibly due to younger age and higher postoperative PT values. A support vector machine (SVM) model showed strong predictive performance (AUC: 0.82; accuracy: 86.08 %; specificity: 96.72 %).
Conclusion
DVT incidence varies by pituitary adenoma subtype. Machine learning enhances predictive models for postoperative DVT in pituitary adenoma patients.
Introduction
Venous thromboembolism (VTE), encompassing both deep vein thrombosis (DVT) and pulmonary embolism, is a common cardiovascular disorder. It typically presents with clinical symptoms such as lower limb swelling, chest pain, tachypnea, and, in severe cases, may result in fatal outcomes [1]. The development of VTE is influenced by three factors known as the Virchow triad: altered venous blood flow, endothelial or vessel wall damage, and hypercoagulability [2]. Surgical procedures can increase the risk of VTE, particularly DVT in the lower extremities, due to intraoperative injuries and postoperative hemodynamic changes [[3], [4], [5]]. In the absence of anticoagulant prophylaxis, the incidence of VTE following brain tumor surgery ranges from 3 % to 30 % [[6], [7], [8]]. Although pituitary adenomas are commonly considered benign cranial tumors, emerging evidence suggests that patients undergoing resection of pituitary adenomas may have a higher risk of postoperative VTE compared to those with other sellar or parasellar tumors such as craniopharyngiomas, meningiomas, or chordomas [9].
This disparity may be attributed to the unique hormone secretion functions of pituitary adenomas, as well as dysregulation of water and electrolyte balance—following surgery. Despite this, the risk factors contributing to the development of postoperative VTE in pituitary adenomas have not been extensively explored. Limited studies have identified a particularly elevated VTE risk in patients with Cushing’s disease, a hormone-secreting subtype of pituitary adenoma [10]. Given the relatively high incidence of postoperative DVT in this population, the present study aims to systematically investigate risk factors associated with lower extremity DVT after pituitary adenoma surgery. Furthermore, we seek to compare thrombotic risk across different clinical subtypes of pituitary adenomas and to construct a tailored risk prediction model to guide perioperative thromboprophylaxis in affected patients.
Filed under: Cushing's, pituitary, symptoms | Tagged: deep venous thrombosis, DVT, Pituitary adenoma, pituitary surgery, venous thromboembolism, VTE | Leave a comment »
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