title: Infection and venous thromboembolism in patients undergoing colorectal surgery: what is the relationship?
abstract: BACKGROUND
  There is evidence demonstrating an association between infection and venous thromboembolism. We recently identified this association in the postoperative setting; however, the temporal relationship between infection and venous thromboembolism is not well defined
  
  
  OBJECTIVE
  We sought to determine the temporal relationship between venous thromboembolism and postoperative infectious complications in patients undergoing colorectal surgery.
  
  
  METHODS
  A retrospective cohort analysis was performed using data for patients undergoing colorectal surgery in the National Surgical Quality Improvement Project 2010 database.
  
  
  METHODS
  The primary outcome measures were the rate and timing of venous thromboembolism and postoperative infection among patients undergoing colorectal surgery during 30 postoperative days.
  
  
  RESULTS
  Of 39,831 patients who underwent colorectal surgery, the overall rate of venous thromboembolism was 2.4% (n = 948); 729 (1.8%) patients were diagnosed with deep vein thrombosis, and 307 (0.77%) patients were diagnosed with pulmonary embolism. Eighty-eight (0.22%) patients were reported as developing both deep vein thrombosis and pulmonary embolism. Following colorectal surgery, the development of a urinary tract infection, pneumonia, organ space surgical site infection, or deep surgical site infection was associated with a significantly increased risk for venous thromboembolism. The majority (52%-85%) of venous thromboembolisms in this population occurred the same day or a median of 3.5 to 8 days following the diagnosis of infection. The approximate relative risk for developing any venous thromboembolism increased each day following the development of each type of infection (range, 0.40%-1.0%) in comparison with patients not developing an infection.
  
  
  CONCLUSIONS
  We are unable to account for differences in data collection, prophylaxis, and venous thromboembolism surveillance between hospitals in the database. Additionally, there is limited patient follow-up.
  
  
  CONCLUSIONS
  These findings of a temporal association between infection and venous thromboembolism suggest a potential early indicator for using certain postoperative infectious complications as clinical warning signs that a patient is more likely to develop venous thromboembolism. Further studies into best practices for prevention are warranted.
authors.affiliation: 1Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 2Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 3Center for Surgical Trials and Outcomes Research, Johns Hopkins Medical Institutions, Baltimore, Maryland 4Armstrong Institute for Patient Safety and Quality Care, Johns Hopkins Medical Institutions, Baltimore, Maryland 5Department of Medicine, Division of Hematology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: M Francesca
authors.initials: MF
authors.lastname: Monn
authors.forename: Xuan
authors.initials: X
authors.lastname: Hui
authors.forename: Brandyn D
authors.initials: BD
authors.lastname: Lau
authors.forename: Michael
authors.initials: M
authors.lastname: Streiff
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Wick
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Efron
authors.forename: Susan L
authors.initials: SL
authors.lastname: Gearhart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology*; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*