Background: Deep vein thrombosis/pulmonary embolus (DVT/PE) is a significant cause of morbidity for surgical patients. The comparative risk across major abdominal procedures is unknown.
Methods: Retrospective analysis of a representative 20% sample of data from 37 states (Nationwide Inpatient Sample) over 5 years (2001-2005). Eight surgeries were identified: bariatric surgery, colorectal surgery, esophagectomy, gastrectomy, hepatectomy, nephrectomy, pancreatectomy, splenectomy. Age <18, patients with multiple major surgeries, or non-elective surgery were excluded. Primary outcome was occurrence of DVT/PE per AHRQ Patient Safety Indicator methodology. Independent variables included age, gender, race, Charlson Comorbidity Index, hospital teaching status, and calendar year.
Results: 244,387 patients were identified, with 2286 DVT/PE (0.94%) (DVT 0.63%, PE 0.39%). Overall death rate was 1.42%, and death rate among DVT/PE was 8.86%. The unadjusted rate (0.35%) and adjusted risk for DVT/PE were lowest among bariatric patients. On multivariate analysis, the highest risk for DVT/PE, relative to bariatric surgery, was esophagectomy (odds ratio 4.45, 95% CI 2.80-7.07), (Figure) and is associated with ,407 excess charges in those patients. The odds ratio of in-hospital mortality for DVT/PE was 4.84 (95% CI 3.98-5.89), and is associated with excess LOS of 9.86 days. This translates into approximately million per year in the US.
Conclusion: The highest risk for DVT/PE following major abdominal surgery was seen in esophagectomy patients while the lowest risk was seen in bariatric patients. Since bariatric patients are known to have greater risk for this complication, these findings may be the result of better awareness and prophyalaxis in this population. Further studies are necessary to quantify the effect of best-practice guidelines, such as in bariatric surgery, on prevention of this costly complication.