Clinical characteristics and outcome of early and late onset pulmonary thromboembolism after neurosurgery: A single-center, retrospective observational study.

Abstract

Pulmonary embolism (PE) following neurosurgical procedures significantly elevates the risk of morbidity and mortality and are suspected to be heterogeneous in terms of their clinical manifestations, such as the early or late postoperative onset. The objective of this study was to identify clinical characteristics that discriminate both phenotypes, and to characterize their differences in clinical outcome. Clinical data of 115 patients who developed PE after neurosurgery in The First Affiliated Hospital of Sun Yat-sen University from January 2017 to June 2025 were retrospectively reviewed. All patients were classified as early-onset PE (≤4 days, n=67) or late-onset PE (>4 days, n= 48). Basic clinical variables and laboratory results were analyzed. A multivariable logistic regression analysis was performed to identify clinical factors independently associated with early-onset PE. 67 out of 115 PEs were diagnosed as early-onset PE. Multivariate analysis showed that the factor independently associated with early-onset PE were a lower preoperative WBC (OR: 0.862, 95% CI: 0.746-0.997, P=0.046) and prolonged surgical duration (OR: 1.222, 95% CI: 1.087-1.374, p<0.001). This study highlight the complexity of post-neurosurgical thrombotic events and the need for tailored clinical management based on patient-specific risk factors and postoperative profiles. Identification of patients at risk of early PE after craniotomy is a challenge, which requires further research.