Emergency operations, multiple operations and perioperative sepsis are independent risk factors for venous thromboembolism
These findings indicate the need for reconsidering standard risk assessment and prophylaxis.
- In this cohort of patients undergoing general surgery, high-risk factors including emergency operations (EO), multiple operations (MO) and perioperative sepsis (PS) were independently associated with post-operative venous thromboembolism (VTE).
- The risk for VTE increased with a combination of any 2 of the high-risk factors and was even more for patients with all 3 high-risk factors.
Why This Matters
- The 3 risk factors analysed in this study were identified in an institutional study of patients who developed VTE despite receiving prophylaxis.
- These factors thus represent conditions when VTE risk is underestimated, and consequently, these high-risk patients receive insufficient prophylaxis.
- EO and MO are not commonly considered independent risk factors for VTE and not included in common VTE risk assessment models.
- This study used patient records from the National Surgical Quality Improvement Program (NSQIP) database to evaluate 1,610,086 patients who underwent general surgery between 2011 and 2014.
- Patients were stratified into VTE and non-VTE groups.
- VTE group included patients who developed a pulmonary embolism (PE) or deep vein thrombosis (DVT) within 30 days of operation and the non-VTE group included those who did not develop PE or DVT within 30 days.
- The association of EO, MO and PS with VTE was assessed.
- Funding: None.
- Overall, 13,673 (0.8%) patients were diagnosed with VTE within 30 days of operation.
- Overall, 14.7%, 2.9% and 9.8% of patients had EO, MO and PS,respectively.
- Patients who developed VTE vs those who did not were more likely to have had:
- EO (24.9% vs 14.7%; P<0.0001);
- MO (17.3% vs 2.8%; P<0.0001); or
- PS (32.3% vs 9.7%; P<0.0001).
- After adjusting for patient characteristics and co-morbidities, the following factors were associated with the risk for VTE:
- EO: (adjusted OR [aOR], 1.4; 95% CI, 1.3-1.5);
- MO: (aOR, 1.9; 95% CI, 1.7-2.0); and
- PS: (aOR, 2.4; 95% CI, 2.2-2.5).
- Patients with any 2 of the high-risk factors had a higher risk for VTE:
- PS+EO: aOR, 2.0; 95% CI, 1.9-2.2;
- MO+EO: aOR, 2.3; 95% CI, 1.9-2.7; and
- PS+MO: aOR, 2.5; 95% CI, 2.2-2.7.
- The combination of all 3 high-risk factors (PS+MO+EO) further increased the risk for VTE (aOR, 2.7; 95% CI, 2.4-3.0).
- The retrospective nature of large database limits available details.
- The usage of mechanical or pharmacologic VTE prophylaxis was not recorded in the NSQIP database.
- Details of VTE prophylaxis were lacking.
- VTE events were not recorded beyond 30 days.
- The data used in this analysis were obtained through 2014 to correlate with previous local series.
- Vaughn SC, Talutis SD, Cassidy MR, Sachs TE, Drake FT, Rosenkranz P, Rao SR, McAneny D. Two novel risk factors for postoperative venous thromboembolism: A reconsideration of standard risk assessment and prophylaxis. Am J Surg. 2020 Jul 8 [Epub ahead of print]. doi: 10.1016/j.amjsurg.2020.06.068. PMID: 32773172