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Predictors of Post Operative Venous Thromboembolism in Colon and Rectal Surgery
Gurdeep S. Matharoo, John Afthinos*, Karen E. Gibbs
Staten Island University Hospital, Staten Island, NY
Background: Venous thromboembolism (VTE) is a significant source of morbidity and mortality during the post operative period for general surgery patients. Pulmonary embolus, a life-threatening, sequela of VTE is associated with 0.8 to 2 % of all deaths in general surgery patients. Abdominal and pelvic surgery carry a high rate of post operative VTE and this risk is increased in patients undergoing surgery for malignancy. We examined a nationwide database to highlight the prevalence and risk factors for developing VTE after colon and rectal surgery.
Methods: The Nationwide Inpatient Data Sample (NIS) was queried for the years 2005 to 2010 for elective open and laparoscopic colo-rectal resections for inflammatory bowel disease, diverticular disease and malignancy. Cases of pre-existing VTE were excluded. The remaining patients were examined for age and comorbid conditions. We evaluated for length of stay and overall morbidity and mortality. The incidence of post operative VTE was evaluated. Univariate and multivariate logistic regression analyses were then performed to identify factors predicting post-operative VTE.
Results: A total of 812,639 patients met the selection criteria. Open surgery was performed on 649,353 (79.9%) patients. Laparoscopic surgery was performed on 163,286 (20.1%) patients. In both open and laparoscopic groups cancer was the most common diagnosis at 57.1 and 38.8 percent, respectively. In the open group 3,624 (0.6%) patients suffered a post operative VTE and 530 (0.3%) in the laparoscopic group. (p<0.001) In both groups the highest incidence was found in patients undergoing left colectomy, 0.77 and 0.5 percent respectively. Independent predictors of post operative VTE are CKD (OR 1.2), CHF (OR 1.7), severe liver disease (OR 2.7), IBD (OR 1.6) and malignancy (OR 1.6). The odds ratio of post operative VTE in open surgery is 1.7 and in laparoscopy is 0.6 (p< 0.001).
Conclusion: Laparoscopy was found to be protective against post operative VTE after colon and rectal surgery. CHF, CKD, severe liver disease, IBD and malignancy were found to be independent predictors of VTE in the post operative period. This information can help surgeons stratify risk in their patient population. Moreover the results can aid in re-evaluating the VTE prophylaxis strategy in this group of patients. Consideration for pre operative prophylaxis may be given in these high risk populations.
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