Abstract
Postoperative thromboembolism (TE) is a serious, but preventable, complication in surgical patients. Orthopedic surgery, neurosurgery, and vascular surgery are considered high risk for TE, and current guidelines recommend TE prophylaxis. However, insufficient data exist regarding TE risk in other general surgeries. This study identified the actual incidence and relative risk of postoperative TE in the real world, according to surgery type. Twenty-six surgeries between 1 December 2017 and 31 August 2019 were selected from the Health Insurance Review and Assessment Service database and analyzed for postoperative TE events. Among all patients, 2.17% had a TE event within 6 months of surgery and 0.75% had a TE event owing to anticoagulant treatment. The incidence of total TE events was the highest in total knee replacement (12.77%), hip replacement (11.46%), and spine surgery (5.98%). The incidence of TE with anticoagulant treatment was the highest in total knee replacement (7.40%), hip replacement (7.20%), and coronary artery bypass graft (CABG) surgery (3.81%). Hip replacement, total knee replacement, CABG surgery, spine surgery, and cardiac surgery except CABG surgery, showed relatively higher risks for total claimed venous TE. The relative risk of venous TE with anticoagulant treatment was the highest for hysterectomy, partial hepatectomy, hip replacement, cardiac surgery except CABG surgery, and total knee replacement. The relative risk of arterial TE was the highest for cardiac surgery, total knee replacement, and hip replacement. In the real world, the incidence of postoperative TE events from total knee replacement and those from hip replacement remain high, and some surgeries could have a relatively higher risk of TE than other surgeries. For patients undergoing these surgeries, studies to reduce the incidence of postoperative TE in clinical practice should be conducted.
Highlights
Using a nationally representative database, this study aimed to identify the real-world incidence and pattern of postoperative TE in patients who had undergone commonly practiced surgeries and assess the relative risk for TE according to the type of surgery
The relative risk of the total claimed venous TE for each surgery, after correcting for TE risk factors, revealed that the highest risk was associated with hip replacement (OR = 7.771, 95% confidence intervals (CIs): 6.749–8.946), total knee replacement (OR = 7.755, 95% CI: 6.747–8.913), and coronary artery bypass graft surgery (OR = 5.183, 95% CI: 4.234–6.344), followed by spine surgery (OR = 4.941, 95% CI: 4.308–5.667), cardiac surgery (OR = 4.584, 95% CI: 3.769–5.575), partial hepatectomy (OR = 4.032, 95% CI: 3.384–4.804), gastrectomy (OR = 3.911, 95% CI: 3.363–4.549), and hysterectomy (OR = 3.751, 95% CI: 3.196–4.403) (Figure 2A)
The relative risk of the total claimed arterial TE for each surgery after correcting for TE risk factors revealed that the highest risk was associated with cardiac surgery (OR = 12.969, 95% CI: 9.422–17.851), total knee replacement (OR = 11.061, 95% CI: 8.669–14.111), and coronary artery bypass graft surgery (OR = 10.567, 95% CI: 7.610–14.673) (Figure 2B)
Summary
To reduce the incidence of postoperative TE, surgical patients may be advised early walking, use of sequential compression devices, and antiplatelet or anticoagulant treatment. This is more apparent in patients who are at risk for TE, namely those with cancer, atrial fibrillation, atrial flutter, or history of TE, as well as those scheduled to undergo surgeries that are known to be high risk for TE [2–5]. In itself, increases the risk of TE, but some surgeries are categorized as having a high risk of postoperative TE [6,7] These surgeries include orthopedic surgery, neurosurgery, and vascular surgery, and current guidelines recommend mechanical and pharmacological prophylaxis for TE in patients undergoing such procedures [5,8,9]. The benefit of adding pharmacological prophylaxis to counteract the risk of bleeding is left to the discretion of the physician [9,11–15]
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