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Preoperative Systemic Inflammation is a Crucial Risk Factor for the Development of Venous Thromboembolism Following Emergency Colon Resection
*Michael DeWane1, Adrian Maung1, Kimberly A. Davis1, Robert M. Becher2, *Jason L. Sperry3, *Matthew R. Rosengart3, *Robert D. Becher1
1Yale School of Medicine, New Haven, CT;2Park Surgical Associates, Brockton, MA;3Univeristy of Pittsbrugh Medical Center, Pittsburgh, PA
Objective: Although venous thromboembolism (VTE) is one of the most serious complications facing postoperative surgical patients, little is known about the risk of VTE following non-trauma surgical emergencies (NTSE). This study investigated the risks and timing of postoperative VTE in patients requiring emergent colon resection (ECR).
Design: Population-based, retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) dataset to identify patients who underwent ECR from 2010-2012. The presence and magnitude of the inflammatory response before operation was stratified into four groups: no inflammation, systemic inflammatory response syndrome (SIRS), sepsis, and septic shock. VTE events were assessed by perioperative metrics and risk factors using adjusted logistic regression.
Setting: Acute care hospitals
Patients: Emergent colon resections
Interventions: N/A
Main Outcome Measure: 30-day VTE
Results: A total of 14,266 patients underwent ECR, 648 (4.5%) of whom developed VTE. Thirty-day VTE rates were significantly different (p<0.0001) among the four inflammation groups, with increasing magnitude of preoperative inflammation associated with increasing probability of VTE (p<0.0001). Adjusted odds ratios indicated that, compared to patients with no inflammation, the odds of VTE from SIRS was 1.39 (p=0.0134), from sepsis was 1.60 (p<0.0001), and from septic shock was 1.85 (p<0.0001). Of the patients who developed VTE, 21% were diagnosed after discharge from the hospital.
Conclusions: Upregulation of the systemic inflammatory response is a significant contributor to high rates of VTE in patients undergoing ECR. The risk of VTE remains increased after hospital discharge; some traditional VTE risks may not be as significant in NTSE. These results reinforce the importance of VTE clinical awareness in NTSE, and indicate that extended thromboprophylaxis in the highest-risk patients may be warranted.
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