Risk for venous thromboembolism is higher in emergency surgery than elective procedures
More invasive surgery is associated with a higher rate of VTE.
In the GAPS non-inferiority randomized controlled trial (RCT) in elective surgical inpatients at moderate or high risk of venous thromboembolism (VTE), administration of pharmacological thromboprophylaxis alone was non-inferior to a combination of pharmacological thromboprophylaxis plus graduated compression stockings (GCS).
- The risk for venous thromboembolism (VTE) is significantly higher with emergency general surgery than elective surgery.
- Emergency surgery and procedures with increased invasiveness are associated with significant risk for VTE.
WHY THIS MATTERS
- This is the first study to compare the rate of VTE in the emergency surgery compared with the same operations performed electively.
- Surgeons and hospitals should promote research and quality improvement processes aimed at patients undergoing elective surgery to prevent and mitigate VTE.
- A more aggressive VTE chemoprophylaxis regimen may be considered for emergency and more invasive surgery.
- A retrospective cohort study of 604,537 patients from the American College of Surgeons National Surgical Quality Improvement Program database.
- Patients underwent cholecystectomies (n=285,847), ventral hernia repairs (VHRs; n=158,500) and partial colectomies (PCs; 160,190) during 2005-2016.
- Primary outcome was VTE at 30 days
- Funding: None disclosed.
- Mean age was 55.3 years.
- Of the procedures, 57.3% were performed laparoscopically.
- Overall rate of VTE within 30 days was 1.1% (deep vein thrombosis [DVT], 0.8% and pulmonary embolism [PE], 0.4%).
- The rate of VTE within 30 days was 1.9% for emergency surgery and 0.8% for elective surgery (P<0.001).
- At 30 days, emergency vs. elective showed significantly higher rate of:
- DVT: 1.4% vs. 0.5% (P<0.001)
- PE: 0.6% vs. 0.3% (P<0.001).
- The rate of VTE was 0.4% for laparoscopic surgery and 2.0% for open surgery.
- The rate of VTE increased with increasing invasiveness of surgery (0.5% for cholecystectomy, 0.8% for VHR and 2.4% for PC; P<0.001).
- The 30-day mortality rate was 9 times higher in patients undergoing emergency vs. elective surgery (3.6% vs. 0.4%; P<0.001).
- On multivariable analysis, independent risk factors for VTE were:
- Emergency general surgery (OR, 1.70; 95% CI, 1.61-1.79; P<0.001);
- Open surgery (OR, 3.38; 95% CI, 3.15-3.63; P<0.001); and
- PC (OR, 1.86; 95% CI, 1.73-1.99; P<0.001).
- Retrospective design.
- The database represents only a sample of procedures performed and therefore, the findings may not be generalisable.
- VTE chemoprophylaxis adherence, dosing or the type of anticoagulants used were not known.
- Information on specific practice locations or facility types was not available
Ross SW, Kuhlenschmidt KM, Kubasiak JC, Mossler LE, Taveras LR, Shoultz TH, Phelan HA, Reinke CE, Cripps MW. Association of the Risk of a Venous Thromboembolic Event in Emergency vs Elective General Surgery. JAMA Surg. 2020 Apr 29 [Epub ahead of print]. doi: 10.1001/jamasurg.2020.0433. PMID: 32347908