Bala Natarajan1, Prateek K. Gupta1, Thomas G. Lynch2, Jason Mactaggart3, Marcus Balters1, Himani Gupta2, G. Matthew Longo3, Jason M. Johanning3, Iraklis I. Pipinos3
1Surgery, Creighton University, Omaha, NE; 2VA Nebraska and Western Iowa Health Care System, Omaha, NE; 3Departments of Surgery, University of Nebraska Medical Center, and VA Nebraska and Western Iowa Health Care System, Omaha, NE.
OBJECTIVES: Recent single-center reports demonstrate high (up to 10%) incidence of postoperative venous thromboembolism (VTE) after major vascular surgery. Moreover, vascular patients rarely receive prolonged prophylaxis despite evidence it reduces post-discharge events. The objective of our study was to use a national, prospective, multicenter database to (1) define the frequency of overall and post-discharge VTE after major vascular operations and (2) assess risk factors associated with VTE development.
METHODS: Patients who experienced a VTE after elective vascular procedures (n=45,548) were identified from 2007-09 NSQIP database. The vascular procedures included: carotid endarterectomy (CEA; n=20785), open thoracoabdominal aneurysm (TAAA) repair (n=361), thoracic endovascular aortic repair (TEVAR; n=732), open abdominal aortic aneurysm (AAA) repair (n=6195), EVAR (n=7,361) and infrainguinal bypass graft (BPG; n=10,114).
RESULTS: VTE occurred in 332 (0.7%) patients (pulmonary embolisms: 0.2%; deep venous thromboses: 0.6%). TAAA repair had the highest rate of VTE (4.2%), followed by TEVAR (2.2%), open AAA repair (1.7%), BPG (1.0%), EVAR (0.7%), and CEA (0.2%) (p<0.0001). Forty-one percent of these VTEs occurred post-discharge. Procedure type, race, general anesthesia, dependent functional status, COPD, CHF, angina, rest pain, and open wound were significantly associated with development of VTE (p<0.05). In those experiencing a VTE, overall mortality increased from 1.5% to 6.0% (p<0.0001).
CONCLUSIONS: Postoperative VTE is associated with type of vascular procedure, and is highest after operations in the chest and abdomen/pelvis. About 40% of VTE events in elective vascular surgery patients occurred post-discharge. Future studies should evaluate the benefit of post-discharge VTE prophylaxis in high-risk patients.
AUTHOR DISCLOSURES: M. Balters, Nothing to disclose; H. Gupta, Nothing to disclose; P. K. Gupta, Nothing to disclose; J. M. Johanning, Nothing to disclose; G. Longo, Nothing to disclose; T. G. Lynch, Nothing to disclose; J. Mactaggart, Nothing to disclose; B. Natarajan, Nothing to disclose; I. I. Pipinos, Nothing to disclose.
Posted April 2012