Abstract
There are limited data regarding predictive factors of postoperative venous thromboembolism (VTE) in patients undergoing colorectal resection. We sought to identify associations between patient comorbidities and postoperative VTE in colorectal resection. The National Surgical Quality Improvement Program (NSQIP) database was used to examine clinical data of patients experiencing postoperative VTE after colorectal resection from 2005 to 2011. Multivariate analysis using logistic regression was performed to quantify risk factors of VTE. We sampled 116,029 patients undergoing colorectal resection. The rate of VTE was 2 % (2,278) with 0.2 % (182) having deep vein thrombosis (DVT) and pulmonary embolism (PE). The first week after operation was the most common time for postoperative VTE. A significant number of patients suffering DVT and PE were diagnosed after index hospital discharge (PE 34.6 %, DVT 29.3 %). The most important risk factors identified for DVT include (P < 0.05) ASA score >2 (adjusted odds ratio (AOR) 1.77) and hypoalbuminemia (serum albumin level <3.5 mg/dl) (AOR 1.69). The most important factors had associations with PE include (P < 0.05) DVT (AOR 14.60) and disseminated cancer (AOR 1.70). Ulcerative colitis (AOR 1.48, P = 0.01) and stage 4 cancer (AOR 1.29, P = 0.02) have associations with DVT. Open colorectal procedures have higher risk of DVT compared to laparoscopic procedures (AOR 1.33, P < 0.01). Postoperative VTE occurs in 2 % of colorectal resections. Thirty percent of VTE events were diagnosed after discharge. Prophylactic treatment of VTE after discharge may have benefits in high-risk patients. Thirteen and eleven perioperative risk factors have associations with DVT and PE, respectively. Emergent admission, open procedures, ulcerative colitis, and stage 4 cancer patients have increased risk of DVT.
Similar content being viewed by others
References
Buchberg B, Masoomi H, Lusby K, et al. Incidence and risk factors of venous thromboembolism in colorectal surgery: does laparoscopy impart an advantage? Arch Surg. 2011;146(6):739–743.
Anderson FA, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151(5):933–938.
Duff J, Walker K, Omari A, Stratton C. Prevention of venous thromboembolism in hospitalized patients: analysis of reduced cost and improved clinical outcomes. J Vasc Nurs. 2013;31(1):9–14.
Shapiro R, Vogel JD, Kiran RP. Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum. 2011;54(12):1496–1502.
Horlander KT, Mannino DM, Leeper KV. Pulmonary embolism mortality in the United States, 1979–1998: an analysis using multiple-cause mortality data. Arch Intern Med. 2003;163(14):1711–1717.
McNally MP, Burns CJ. Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg. 2009;22(1):34–40.
Lyman GH, Khorana AA, Falanga A, et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007;25(34):5490–5505.
Lyman GH, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013;31(17):2189–2204.
Huber O, Bounameaux H, Borst F, Rohner A. Postoperative pulmonary embolism after hospital discharge. An underestimated risk. Arch Surg. 1992;127(3):310–313.
National Surgical Quality Improvement Program [home page on the Internet] Chicago, IL: American College of Surgeons; 2005. [cited 2012 Jan 17]. Available from: www.acsnsqip.org.
Moghadamyeghaneh Z, Mills SD, Pigazzi A, Carmichael JC, Stamos MJ. Risk Factors of Postoperative Upper Gastrointestinal Bleeding Following Colorectal Resections. J Gastrointest Surg. 2014.
Bernstein CN, Blanchard JF, Houston DS, Wajda A. The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population-based cohort study. Thromb Haemost. 2001;85(3):430–434.
Flordal PA, Berggvist D, Burmark US, Ljungström KG, Törngren S. Risk factors for major thromboembolism and bleeding tendency after elective general surgical operations. The Fragmin Multicentre Study Group. Eur J Surg. 1996;162(10):783–789.
Lorence DP, Ibrahim IA. Benchmarking variation in coding accuracy across the United States. J Health Care Finance. 2003;29(4):29–42.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was presented as a lunchtime poster presentation at the Tripartite Colorectal Meeting 2014 last July 1, 2014, in Birmingham, UK.
Rights and permissions
About this article
Cite this article
Moghadamyeghaneh, Z., Hanna, M.H., Carmichael, J.C. et al. A Nationwide Analysis of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Colon and Rectal Surgery. J Gastrointest Surg 18, 2169–2177 (2014). https://doi.org/10.1007/s11605-014-2647-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-014-2647-5