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WASHINGTON - Cardiac and vascular surgery patients are at higher risk for deep vein thrombosis than are general surgery patients, according to data presented at the annual clinical congress of the American College of Surgeons.
In a retrospective analysis of 2,669,772 patients with a median age of 64 years, 43% of whom were males, in the ACS-National Surgical Quality Improvement Program (NSQIP) during 2005-2009, Dr. Faisal Aziz of Penn State Hershey (Pa.) Heart and Vascular Institute and his colleagues sought to determine the actual rate of deep vein thrombosis (DVT) during revascularization procedures, compared with general surgery.
The researchers sorted patients according to DVT risk factors such as age, gender, body mass index over 40 kg/m2, and whether the surgery was acute. They then assessed intraoperative factors such as total time to completion and the American Society of Anesthesiology score. They then considered the postoperative factors associated with DVT, such as blood transfusions, return to the operating room, deep wound infection, cardiac arrest, and mortality.
There were 18,512 incidences of DVT, equaling 0.69% of all patients studied. Of those, 0.66% occurred during general surgery, 2.08% occurred during cardiac surgery, and 1% occurred during vascular surgery.
"The implications of our study are that, contrary to popular belief, the incidence of postop DVT is actually higher after cardiac surgery and vascular surgery procedures," he said.
The cardiac surgery procedures associated with the highest DVT incidence rate were tricuspid valve replacement (8%), thoracic endovascular aortic repair (5%), thoracic aortic graft replacement (4%), and pericardial window (4%).
In a comparison of cardiac procedures, tricuspid valve replacement vs. aortic valve replacement had a risk ratio of 3.5 (P < .001). In tricuspid valve replacement vs. coronary artery bypass, the former had a risk ratio of 11.24 (P < .001).
Vascular surgeries with the highest DVT incidence rates were peripheral bypass (1%), amputation (trans-metatarsal, 0.75%; below knee, 1%; above the knee, 1%), and ruptured aortic aneurysms (3.5%).
Comparatively, in ruptured endovascular aneurysm repair (EVAR) vs. elective EVAR, the risk ratio was 3.55 (P < .001). In abdominal aortic aneurysm (AAA) repair, ruptured vs. elective surgeries had a risk ratio of 2.37 (P < .001).
Compared with 80% of general surgery patients, 74% of cardiac surgery patients were 70 years or older (relative risk, 1.12; P = .13); 86% of vascular surgery patients were 70 years or older (RR, 1.1; P < .05).
Male gender was an associated risk factor in 49% of general surgery patients, compared with 70% for cardiac patients (RR, 1.4; P < .001) and 51% for vascular patients (RR, 1.1; P < .001).
Intra- and postoperative factors associated with DVT risk included operation times exceeding 240 minutes and previous DVT. Compared with 21% of general surgery patients, operation time was implicated in 59% of cardiac surgery patients (relative risk, 2.72; P < .001) and 25% of vascular surgery patients (RR, 1.14; P <.001). Blood transfusions affected 13% of cardiac surgery patients (RR, 2.3; P < .001), 6% of vascular surgery patients (RR, 1.3; P < .001), and 6% of general surgery patients.
Compared with 24% for general surgery patients, returning to the operating room was implicated in 27% of cardiac patients (RR, 1.4; P = .27) and 32% of vascular surgery patients (RR, 1.3; P < .001).
"Procedures and perioperative factors associated with high risk of postoperative DVT should be identified, and adequate DVT prophylaxis should be ensured for these patients," Dr. Aziz concluded.
He had no disclosures.
WASHINGTON - Cardiac and vascular surgery patients are at higher risk for deep vein thrombosis than are general surgery patients, according to data presented at the annual clinical congress of the American College of Surgeons.
In a retrospective analysis of 2,669,772 patients with a median age of 64 years, 43% of whom were males, in the ACS-National Surgical Quality Improvement Program (NSQIP) during 2005-2009, Dr. Faisal Aziz of Penn State Hershey (Pa.) Heart and Vascular Institute and his colleagues sought to determine the actual rate of deep vein thrombosis (DVT) during revascularization procedures, compared with general surgery.
The researchers sorted patients according to DVT risk factors such as age, gender, body mass index over 40 kg/m2, and whether the surgery was acute. They then assessed intraoperative factors such as total time to completion and the American Society of Anesthesiology score. They then considered the postoperative factors associated with DVT, such as blood transfusions, return to the operating room, deep wound infection, cardiac arrest, and mortality.
There were 18,512 incidences of DVT, equaling 0.69% of all patients studied. Of those, 0.66% occurred during general surgery, 2.08% occurred during cardiac surgery, and 1% occurred during vascular surgery.
"The implications of our study are that, contrary to popular belief, the incidence of postop DVT is actually higher after cardiac surgery and vascular surgery procedures," he said.
The cardiac surgery procedures associated with the highest DVT incidence rate were tricuspid valve replacement (8%), thoracic endovascular aortic repair (5%), thoracic aortic graft replacement (4%), and pericardial window (4%).
In a comparison of cardiac procedures, tricuspid valve replacement vs. aortic valve replacement had a risk ratio of 3.5 (P < .001). In tricuspid valve replacement vs. coronary artery bypass, the former had a risk ratio of 11.24 (P < .001).
Vascular surgeries with the highest DVT incidence rates were peripheral bypass (1%), amputation (trans-metatarsal, 0.75%; below knee, 1%; above the knee, 1%), and ruptured aortic aneurysms (3.5%).
Comparatively, in ruptured endovascular aneurysm repair (EVAR) vs. elective EVAR, the risk ratio was 3.55 (P < .001). In abdominal aortic aneurysm (AAA) repair, ruptured vs. elective surgeries had a risk ratio of 2.37 (P < .001).
Compared with 80% of general surgery patients, 74% of cardiac surgery patients were 70 years or older (relative risk, 1.12; P = .13); 86% of vascular surgery patients were 70 years or older (RR, 1.1; P < .05).
Male gender was an associated risk factor in 49% of general surgery patients, compared with 70% for cardiac patients (RR, 1.4; P < .001) and 51% for vascular patients (RR, 1.1; P < .001).
Intra- and postoperative factors associated with DVT risk included operation times exceeding 240 minutes and previous DVT. Compared with 21% of general surgery patients, operation time was implicated in 59% of cardiac surgery patients (relative risk, 2.72; P < .001) and 25% of vascular surgery patients (RR, 1.14; P <.001). Blood transfusions affected 13% of cardiac surgery patients (RR, 2.3; P < .001), 6% of vascular surgery patients (RR, 1.3; P < .001), and 6% of general surgery patients.
Compared with 24% for general surgery patients, returning to the operating room was implicated in 27% of cardiac patients (RR, 1.4; P = .27) and 32% of vascular surgery patients (RR, 1.3; P < .001).
"Procedures and perioperative factors associated with high risk of postoperative DVT should be identified, and adequate DVT prophylaxis should be ensured for these patients," Dr. Aziz concluded.
He had no disclosures.
WASHINGTON - Cardiac and vascular surgery patients are at higher risk for deep vein thrombosis than are general surgery patients, according to data presented at the annual clinical congress of the American College of Surgeons.
In a retrospective analysis of 2,669,772 patients with a median age of 64 years, 43% of whom were males, in the ACS-National Surgical Quality Improvement Program (NSQIP) during 2005-2009, Dr. Faisal Aziz of Penn State Hershey (Pa.) Heart and Vascular Institute and his colleagues sought to determine the actual rate of deep vein thrombosis (DVT) during revascularization procedures, compared with general surgery.
The researchers sorted patients according to DVT risk factors such as age, gender, body mass index over 40 kg/m2, and whether the surgery was acute. They then assessed intraoperative factors such as total time to completion and the American Society of Anesthesiology score. They then considered the postoperative factors associated with DVT, such as blood transfusions, return to the operating room, deep wound infection, cardiac arrest, and mortality.
There were 18,512 incidences of DVT, equaling 0.69% of all patients studied. Of those, 0.66% occurred during general surgery, 2.08% occurred during cardiac surgery, and 1% occurred during vascular surgery.
"The implications of our study are that, contrary to popular belief, the incidence of postop DVT is actually higher after cardiac surgery and vascular surgery procedures," he said.
The cardiac surgery procedures associated with the highest DVT incidence rate were tricuspid valve replacement (8%), thoracic endovascular aortic repair (5%), thoracic aortic graft replacement (4%), and pericardial window (4%).
In a comparison of cardiac procedures, tricuspid valve replacement vs. aortic valve replacement had a risk ratio of 3.5 (P < .001). In tricuspid valve replacement vs. coronary artery bypass, the former had a risk ratio of 11.24 (P < .001).
Vascular surgeries with the highest DVT incidence rates were peripheral bypass (1%), amputation (trans-metatarsal, 0.75%; below knee, 1%; above the knee, 1%), and ruptured aortic aneurysms (3.5%).
Comparatively, in ruptured endovascular aneurysm repair (EVAR) vs. elective EVAR, the risk ratio was 3.55 (P < .001). In abdominal aortic aneurysm (AAA) repair, ruptured vs. elective surgeries had a risk ratio of 2.37 (P < .001).
Compared with 80% of general surgery patients, 74% of cardiac surgery patients were 70 years or older (relative risk, 1.12; P = .13); 86% of vascular surgery patients were 70 years or older (RR, 1.1; P < .05).
Male gender was an associated risk factor in 49% of general surgery patients, compared with 70% for cardiac patients (RR, 1.4; P < .001) and 51% for vascular patients (RR, 1.1; P < .001).
Intra- and postoperative factors associated with DVT risk included operation times exceeding 240 minutes and previous DVT. Compared with 21% of general surgery patients, operation time was implicated in 59% of cardiac surgery patients (relative risk, 2.72; P < .001) and 25% of vascular surgery patients (RR, 1.14; P <.001). Blood transfusions affected 13% of cardiac surgery patients (RR, 2.3; P < .001), 6% of vascular surgery patients (RR, 1.3; P < .001), and 6% of general surgery patients.
Compared with 24% for general surgery patients, returning to the operating room was implicated in 27% of cardiac patients (RR, 1.4; P = .27) and 32% of vascular surgery patients (RR, 1.3; P < .001).
"Procedures and perioperative factors associated with high risk of postoperative DVT should be identified, and adequate DVT prophylaxis should be ensured for these patients," Dr. Aziz concluded.
He had no disclosures.