Postoperative Venous Thromboembolism Rates Vary Significantly After Different Types of Major Abdominal Operations
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Venous thrombolism (VTE) is a significant cause of morbidity for surgical patients. Comparative risk across major procedures is unknown.
Retrospective analysis of the Nationwide Inpatient Sample (2001–2005) was conducted. Eight surgeries were identified: bariatric surgery, colorectal surgery, esophagectomy, gastrectomy, hepatectomy, nephrectomy, pancreatectomy, splenectomy. Age < 18, patients with multiple major surgeries, and those admitted for treatment of VTE were excluded. Primary outcome was occurrence of VTE. Independent variables included age, gender, race, Charlson score, hospital teaching status, elective procedures, cancer/metastasis, trauma, and year.
Patients, 375,748, were identified, 5,773 (1.54%) with VTE. Overall death rate was 3.97%, but 13.34% after VTE. Unadjusted rate (0.35%) and adjusted risk for VTE were lowest among bariatric patients. On multivariate analysis, highest risk for VTE was splenectomy (odds ratio 2.69, 95% CI 2.03–3.56). Odds ratio of in-hospital mortality following VTE was 1.84 (1.65–2.05), associated with excess stay of 10.88days and $9,612 excess charges, translating into $55 million/year nationwide.
Highest risk for VTE was associated with splenectomy, lowest risk with bariatric surgery. Since bariatric patients are known to have greater risk for this complication, these findings may reflect better awareness/prophylaxis. Further studies are necessary to quantify effect of best-practice guidelines on prevention of this costly complication.
KeywordsDeep vein thrombosis Pulmonary embolism Bariatic surgery Major abdominal surgery
- 9.Pezzuoli G, Neri Serneri GG, Settembrini P et al. Prophylaxis of fatal pulmonary embolism in general surgery using low-molecular weight heparin Cy 216: a multicentre, double-blind, randomized, controlled, clinical trial versus placebo (STEP). STEP-Study Group. Int Surg 1989;74:205–210.PubMedGoogle Scholar
- 15.Ghanim AJ, Daskalakis C, Eschelman DJ et al. A five-year, retrospective, comparison review of survival in neurosurgical patients diagnosed with venous thromboembolism and treated with either inferior vena cava filters or anticoagulants. J Thromb Thrombolysis 2007;24:247–254. doi:10.1007/s11239-007-0025-9.PubMedCrossRefGoogle Scholar
- 23.Thromboembolic Risk Factors (THRIFT) Consensus Group. Risk of and prophylaxis for venous thromboembolism in hospital patients. BMJ 1992;305:567–574.Google Scholar
- 33.Nicolaides A, Irving D, Pretzell M et al. The risk of deep-vein thrombosis in surgical patients. Br J Surg 1973;60:312.Google Scholar
- 50.Mommertz G, Sigala F, Glowka TR et al. Differences of venous thromboembolic risks in vascular general and trauma surgery patients. J Cardiovasc Surg (Torino) 2007;48:727–733.Google Scholar
- 51.Nicolaides AN, Irving D. Clinical factors and the risk of deep venous thrombosis. In Nicolaides AN, ed. Thromboembolism etiology: advances in prevention and management. Baltimore, MD: Thromboembolism etiology: advances in prevention and management, 1975 193–204.Google Scholar