Symptomatic venous thromboembolism after transsphenoidal surgery in Cushing's disease: incidence and risk factors

Cushing's Disease (CD) has been linked to increased venous thromboembolism (VTE) risk. This study investigates the incidence and risk factors of postoperative VTE in patients undergoing transsphenoidal surgery (TSS) for CD.

This retrospective study analyzed patients with CD and non-functioning pituitary adenomas (NFPAs) who underwent TSS at Massachusetts General Hospital from 2005 to 2019. The incidence of VTE within 90 days post-TSS was compared between groups, with early VTE defined as occurring within 7 days. VTE diagnosis was confirmed through imaging, including ultrasound and CT, following clinical suspicion.

Of six CD patients with symptomatic post-TSS VTE, five developed VTE within one week ("early"), while no NFPA patients experienced early VTE (p = 0.006). Two CD patients presented with pulmonary embolism (PE) on postoperative day (POD) 1 or 2. Two of three with early deep venous thrombosis (DVT) had a history of prior DVT. The overall post-TSS VTE incidence was similar between CD and NFPA patients [6/315 (1.9%) vs. 4/559 (0.7%), p = 0.18]. Patients with CD who developed post-TSS VTE had significantly higher rates of prior history of VTE (p = 0.003) and hypertension (p = 0.038) and larger tumor sizes (p = 0.045) compared to those without post-TSS VTE on univariate analysis.

CD patients are at higher risk for early post-TSS VTE, including symptomatic PE. Identifying high-risk patients and implementing perioperative prophylaxis in the immediate postoperative period may help mitigate these complications. Further research is needed to optimize prevention strategies in this population.