title: In-hospital and postdischarge venous thromboembolism after vascular surgery.
abstract: OBJECTIVE
  Recent single-center reports demonstrate a high (up to 10%) incidence of postoperative venous thromboembolism (VTE) after major vascular surgery. Moreover, vascular patients rarely receive prolonged prophylaxis despite evidence that it reduces thromboembolic events after discharge. This study used a national, prospective, multicenter database to define the incidence of overall and postdischarge VTE after major vascular operations and assess risk factors associated with VTE development.
  
  
  METHODS
  Patients with VTE who underwent elective vascular procedures (n = 45,548) were identified from the 2007-2009 National Surgical Quality Improvement Program (NSQIP) database. The vascular procedures included carotid endarterectomy (CEA; n = 20,785), open thoracoabdominal aortic aneurysm (TAAA) repair (n = 361), thoracic endovascular aortic repair (TEVAR; n = 732), open abdominal aortic (OAA) surgery (n = 6195), endovascular aneurysm repair (EVAR; n = 7361), and infrainguinal bypass graft (BPG; n = 10,114). Univariable and multivariable analyses were performed to ascertain risk factors associated with VTE.
  
  
  RESULTS
  VTE was diagnosed in 187 patients (1.3 %) who underwent aortic surgery, with TAAA repair having the highest rate of VTE (4.2%), followed by TEVAR (2.2%), OAA surgery (1.7%), and EVAR (0.7%). In this subgroup, pulmonary embolisms (PE) were diagnosed in 52 (0.4%) and deep venous thrombosis (DVT) in 144 (1%). VTE rates were 1.0% and 0.2% for patients who underwent a BPG or CEA, respectively. Forty-one percent of all VTEs were diagnosed after discharge. The median (interquartile range) number of days from surgery to PE and DVT were 10 (5-15) and 10 (4-18), respectively. On multivariable analyses, type of surgical procedure, totally dependent functional status, disseminated cancer, postoperative organ space infection, postoperative cerebrovascular accident, failure to wean from ventilator ≤48 hours, and return to the operating room were significantly associated with development of VTE. In those experiencing a DVT or PE, overall mortality increased from 1.5% to 6.2% and from 1.5% to 5.7% respectively (P < .05 for both).
  
  
  CONCLUSIONS
  Postoperative VTE is associated with the 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 were diagnosed after discharge, and the presence of VTE was associated with a quadrupled mortality rate. Future studies should evaluate the benefit of DVT screening and postdischarge VTE prophylaxis in high-risk patients.
authors: Creighton University, Omaha, Neb, USA.
authors: Bala
authors: B
authors: Ramanan
authors: Prateek K
authors: PK
authors: Gupta
authors: Abhishek
authors: A
authors: Sundaram
authors: Thomas G
authors: TG
authors: Lynch
authors: Jason N
authors: JN
authors: MacTaggart
authors: B Timothy
authors: BT
authors: Baxter
authors: Jason M
authors: JM
authors: Johanning
authors: Iraklis I
authors: II
authors: Pipinos
mesh_terms: D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D018570:Risk Assessment; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology*