Samuel W Ross, MD, MPH1, John C Kubasiak, MD2, Lindsey P Mossler, MD3, Luis R Taveras, MD2, Thomas H Shoultz, MD2, Herbert A Phelan, MD2, Michael W Cripps, MD2. 1Carolinas Medical Center, 2University of Texas Southwestern Medical Center, 3University of Indiana School of Medicine
Introduction: Trauma patients have an increased risk of VTE partly due to increased inflammation, and, therefore, are recommended to have increased VTE chemoprophylaxis dosing. A similar inflammatory physiology occurs in the patients with Emergency General Surgery (EGS) operative pathology, however, it is not well studied if this process leads to an increased VTE risk in this population. We hypothesized that EGS cases have a higher risk of VTE than their elective counterparts.
Methods: The American College of Surgeons NSQIP database was queried from 2005-2016 for all open and laparoscopic cholecystectomies (OC and LC), ventral hernia repairs (OVHR and LVHR), and partial colectomies (OPC and LPC) to give a sample of commonly encountered EGS procedures that have elective counterparts. Elective surgeries were then compared to emergent ones using univariate statistics with VTE at 30 days being the primary outcome. A multivariate analysis controlling for age, gender, BMI, cancer, bleeding disorders, pregnancy, surgery type, and open status was then performed.
Results: There were 604,537 surgeries over 12 years: 285,847 cholecystectomies (12.7% OC vs. 87.3% LC); 158,500 VHR (79.8% OVHR vs. 20.2% LVHR); and 160,190 partial colectomies (61.3% OPC and 38.7% LPC). There were 4,607 (0.8%) patients with DVT and 2,648 (0.4%) with PE, and a total 6,624 (1.1%) patients with VTE. Patients with emergent surgery were more likely to be younger, male, lower BMI, and have higher white blood counts and lower albumin (p<0.001 for all). Patient outcomes by emergent status are displayed in Table 1. When VTE risk was examined by open versus laparoscopic surgery, as expected, VTE risk increased with invasiveness (2.0 vs 0.3% for all; 2.3 vs. 0.3% for cholecystectomy, 1.0 vs. 0.4% for VHR, and 3.2 vs. 1.2% for partial colectomy; p<0.001 for all). On multivariate analysis, emergent surgery was an independent predictor of VTE (OR 1.8; 95% CI 1.4-2.2), with almost twice the odds of VTE as elective surgery. As was open surgery (2.7, 2.0-3.5) with almost three times the risk of VTE when controlling for emergent status. Additionally, more extensive surgeries had higher VTE odds when compared to cholecystectomy; VHR (1.8, 1.4-2.4) and partial colectomy (3.1, 2.4-4.0).
Conclusion: Emergent surgery was an independent predictor of VTE when compared to their elective counterparts. Given this increased risk, higher dosing and earlier VTE chemoprophylaxis should be considered in emergent and more extensive operations, especially when performed open, to reduce the risk of potentially lethal VTE.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95071
Program Number: P021
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster