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Abstract

Introduction: Venous thromboembolic disease (VTE), comprised of pulmonary embolism (PE) and deep vein thrombosis (DVT), results in significant postoperative morbidity and mortality with increased resource utilization. Hypothesis: Patients who undergo emergent general surgery procedures have increased risk of postoperative VTE complications. Methods: Demographic and clinical data between Jan 2006 to Sept 2011 were prospectively collected on general surgical inpatients as part of the Michigan Surgical Quality Collaborative[1]. Patients who did not undergo general anesthesia were excluded. Race, gender, age (<45 years, 45-65 years, 65-75 years, and >75 years old), ASA classification (1-2 vs. 3-5), operative times, and preoperative functional status were further evaluated as risk factors for development of VTE. Data analysis included Chi-square and logistic regression analysis. Results: Of 91,448 general surgery inpatients, there were 72,862 elective (EL) and 18,586 emergent (EM) cases. Within the EM cohort, there were 13,089 white patients, 2839 blacks, and 2639 other/unknown; 8787 were male. A total of 1481 patients were mechanically ventilated for >48 hours (914 EM), 1024 had SIRS (183 EM), 786 had sepsis (226 EM), and 317 had septic shock (157 EM). EM patients had higher rates of DVT (1.87% EM vs. 0.89% EL, P<0.001) and higher rates of PE (0.56% EM vs. 0.44% EL, P = 0.027). Using logistic regression, we found that race and gender did not affect VTE rates in EM patients; however, age >45 years (p=0.01), increased operative time (P<0.001) and increased ASA classification (P <0.001) were significant risk factors for both DVT and PE in EM patients. Additionally, preoperative functional status was a significant risk factor for DVT (P<0.001) but not for PE. Conclusions: Emergency surgery patients had a significantly higher rate of developing VTE events. Among EM patients, age, operative time, ASA classification, and preoperative functional status are significant risk factors for DVT development; only age, operative time and ASA classifications were risk factors for PE development. In emergency surgery patients, operative time may be a modifiable variable and optimal VTE prophylaxis must be examined as targets for performance improvement. Reference: [1]Campbell DA Jr, Kubus JJ, Henke PK, Hutton M, Englesbe MJ. The Michigan Surgical Quality Collaborative: a legacy of Shukri Khuri. Am J Surg. 2009 Nov;198(5 Suppl):S49-55.