Association between preoperative chronic steroid use and pulmonary embolism in adult tumor craniotomy: Linking role of platelet-to-white blood cell ratio.

Previous studies indicate that preoperative chronic steroid use is associated with an increased risk of postoperative pulmonary embolism (PE) in adult patients undergoing tumor craniotomy. We aimed to evaluate whether the platelet-to-white blood cell (PLT/WBC) ratio may partially explain the association. This retrospective study involved a secondary analysis of data from the American College of Surgeons National Surgical Quality Improvement Program database, encompassing 15,274 patients who underwent tumor craniotomy. Multivariable logistic regression was performed to assess the association between preoperative chronic steroid use and 30-day postoperative PE. Furthermore, a mediation analysis was performed to explore the role of the PLT/WBC ratio in this association. Preoperative chronic steroid use was present in 15.18% (n = 2,319) of patients, and the rate of postoperative PE was 1.41% (n = 215), with a higher rate in chronic steroid users compared to non-users (2.37% vs. 1.24%). Multivariable analysis revealed a positive association between preoperative chronic steroid use and postoperative PE (OR = 1.90, 95% CI: 1.24, 2.90). Mediation analysis demonstrated that the PLT/WBC ratio significantly explained part of the association between chronic steroid use and postoperative PE (P = 0.006). Our findings further supported the association between preoperative chronic steroid use and elevated odds of postoperative PE in adults undergoing tumor craniotomy. Additionally, our analysis revealed that preoperative PLT/WBC ratio potentially acts as a partial linking factor in this association. Future studies are required to substantiate these findings.