Emergency surgery linked to higher risk for venous thromboembolism
Click Here to Manage Email Alerts
Trauma patients who underwent emergency general surgery appeared to have a twofold higher risk for venous thromboembolism than patients who underwent elective surgery, according to study results published in JAMA Surgery.
Researchers noted that a more aggressive VTE chemoprophylaxis regimen should be considered for these patients.
“Trauma patients have an increased risk for VTE partly because of greater inflammation. However, it is unknown if this association is present in patients who undergo emergency general surgery,” Samuel W. Ross, MD, MPH, researcher in the department of acute care surgery at Carolinas Medical Center, and colleagues wrote.
For this reason, investigators sought to examine whether emergency case status was independently associated with increased VTE risk compared with elective case status among 604,537 adults (mean age, 55.3 years; 61.4% women) and to test the hypothesis that emergency cases carry a higher risk for VTE.
Researchers pooled data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database between 2005 and 2016 on three common procedures: cholecystectomies (n = 285,847), ventral hernia repairs (n = 158,500) and partial colectomies (n = 160,190). The rate of VTE within 30 days served as the primary outcome.
Results showed 30-day VTE rates of 1.9% for emergency general surgery and 0.8% for elective surgery (P < .001).
Researchers observed a total of 6,624 VTEs (1.1%) among the cohort. When they examined VTE risk by surgery type, they found the risk for VTE increased with surgical invasiveness, from 0.5% with cholecystectomy and 0.8% with ventral hernia repairs to 2.4% with partial colectomies (P < .001).
Results of multivariable analysis that controlled for age, sex, BMI, bleeding disorder, disseminated cancer, laparoscopy approach and surgery type showed independent associations between VTE and emergency surgery (OR = 1.7; 95% CI, 1.61-1.79), open surgery (OR = 3.38; 95% CI, 3.15-3.63) and partial colectomies (OR = 1.86; 95% CI, 1.73-1.99).
“Further study on methods to improve VTE chemoprophylaxis is highly recommended for emergency and more extensive operations to reduce the risk for potentially lethal VTE,” the researchers wrote.
The work by Ross and colleagues has identified an important area for quality improvement, but without investment of time, energy and financial resources, it will be impossible to improve outcomes in emergency general surgery, Patrick B. Murphy, MD, MPH, MSc, oncologist at Williamson Medical Center, and Elliott R. Haut, MD, PhD, associate professor of surgery at Johns Hopkins Medicine, wrote in an accompanying commentary.
“There are no best practice guidelines for VTE prophylaxis in patients undergoing emergency general surgery, although we have suggested an algorithm extrapolated from the medical and surgical literature,” the commentary authors wrote. “Ross and colleagues include a strong call to action, advocating for reporting of important process measures in the NSQIP, a known limitation of the program, which lacks data on VTE risk assessment and prophylaxis, as we and others have been suggesting since 2013. Without these data, one can only speculate on the potential causes of higher rates of VTE in the emergency general surgery population.”
Reference:
Collapse
Read more about
Click Here to Manage Email Alerts