PS128. In-Hospital and Post-Discharge Venous Thromboembolism after Vascular Surgery

Abstract

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. Patients who experienced a VTE after elective vascular procedures (n=45548) 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=7361) and infrainguinal bypass graft (BPG; n=10114). 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 <.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 < .05). In those experiencing a VTE, overall mortality increased from 1.5% to 6.0% (P <.0001). 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.