Impact of venous thromboembolism on clinical outcomes in patients with brain cancer: A national inpatient sample analysis from 2018-2020

Abstract Background: Venous thromboembolism (VTE) is a common and serious complication in brain cancer patients, associated with increased morbidity and mortality. This study evaluates the impact of VTE on clinical outcomes and healthcare resource utilization during hospitalizations for brain cancer in a nationally representative U.S. cohort. Methods: We conducted a retrospective analysis of the National Inpatient Sample (2018–2020), identifying adult hospitalizations with a primary diagnosis of brain cancer. Patients were stratified based on the presence of a clinically relevant VTE diagnosis. Multivariable regression models adjusted for demographic, clinical, and hospital-level characteristics were used to assess associations with in-hospital mortality, length of stay (LOS), and inflation-adjusted total hospital charges. Results: Among 108,245 brain cancer hospitalizations, 2,015 (1.86%) involved VTE. Compared to patients without VTE, those with VTE were older (median age, 65 vs 59 years, p < 0.001), more often male (65% vs 58%, p = 0.009), and had a higher burden of comorbidities (median, 4.0 vs 3.0, p < 0.001). Sepsis (8.7% vs 0.8%), anemia (21.0% vs 11.0%), heart failure (5.0% vs 2.3%), and liver disease (4.5% vs 2.3%) were significantly more common in the VTE group (p<0.001). In-hospital mortality was markedly higher in patients with VTE (11.0% vs 2.2%, p<0.001). Adjusted analysis showed that patients without VTE had 71% lower odds of inpatient mortality (OR, 0.29; 95%CI, 0.20 - 0.43; p < 0.001). Median LOS was longer in the VTE group (9.0 vs 4.0 days), and adjusted LOS was 5.2 days shorter in the non-VTE group (p<0.001). Median total hospital charges were significantly higher in the VTE group ($126,036 vs $92,901), with an adjusted increase of $57,302 (p<0.001). Among VTE patients, sepsis had the greatest impact on mortality (OR 10.8), hospital charges (+$293,197) and LOS (+17 days) (p<0.001). Conclusions: VTE in hospitalized brain cancer patients is independently associated with increased mortality, longer hospital stays, and higher healthcare costs. These findings highlight the importance of targeted thromboprophylaxis strategies for high-risk populations.