Association of the risk of a venous thromboembolic event in emergency vs elective general surgery

Samuel W. Ross, Kali M. Kuhlenschmidt, John C. Kubasiak, Lindsey E. Mossler, Luis R. Taveras, Thomas H. Shoultz, Herbert Phelan, Caroline E. Reinke, Michael W. Cripps

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Abstract

Importance: Trauma patients have an increased risk of venous thromboembolism (VTE), partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery (EGS). Objectives: To investigate whether emergency case status is independently associated with VTE compared with elective case status and to test the hypothesis that emergency cases would have a higher risk of VTE. Design, Setting, and Participants: This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database from January 1, 2005, to December 31, 2016, for all cholecystectomies, ventral hernia repairs (VHRs), and partial colectomies (PCs) to obtain a sample of commonly encountered emergency procedures that have elective counterparts. Emergency surgeries were then compared with elective surgeries. The dates of analysis were January 1 to 31, 2019. Main Outcomes and Measures: The primary outcome was VTE at 30 days. A multivariable analysis controlling for age, sex, body mass index, bleeding disorder, disseminated cancer, laparoscopy approach, and surgery type was performed. Results: There were 604537 adults undergoing surgical procedures over 12 years (mean [SD] age, 55.3 [16.6] years; 61.4% women), including 285847 cholecystectomies, 158500 VHRs, and 160190 PCs. The rate of VTE within 30 days was 1.9% for EGS and 0.8% for elective surgery, a statistically significant difference. Overall, 4607 patients (0.8%) had deep vein thrombosis, and 2648 patients (0.4%) had pulmonary embolism. A total of 6624 VTEs (1.1%) occurred in the cohort. As expected, when VTE risk was examined by surgery type, the risk increased with invasiveness (0.5% for cholecystectomy, 0.8% for VHR, and 2.4% for PC; P <.001). On multivariable analysis, EGS was independently associated with VTE (odds ratio [OR], 1.70; 95% CI, 1.61-1.79). Also associated with VTE were open surgery (OR, 3.38; 95% CI, 3.15-3.63) and PC (OR, 1.86; 95% CI, 1.73-1.99). Conclusions and Relevance: In this cohort study, emergency surgery and increased invasiveness appeared to be independently associated with VTE compared with elective surgery. Further study on methods to improve VTE chemoprophylaxis is highly recommended for emergency and more extensive operations to reduce the risk of potentially lethal VTE.

Original languageEnglish (US)
Pages (from-to)503-511
Number of pages9
JournalJAMA Surgery
Volume155
Issue number6
DOIs
StatePublished - Jun 2020

ASJC Scopus subject areas

  • Surgery

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    Ross, S. W., Kuhlenschmidt, K. M., Kubasiak, J. C., Mossler, L. E., Taveras, L. R., Shoultz, T. H., Phelan, H., Reinke, C. E., & Cripps, M. W. (2020). Association of the risk of a venous thromboembolic event in emergency vs elective general surgery. JAMA Surgery, 155(6), 503-511. https://doi.org/10.1001/jamasurg.2020.0433