title: Impact of sepsis on risk of postoperative arterial and venous thromboses: large prospective cohort study.
abstract: OBJECTIVE
  To evaluate the impact of preoperative sepsis on risk of postoperative arterial and venous thromboses.
  
  
  METHODS
  Prospective cohort study using the National Surgical Quality Improvement Program database of the American College of Surgeons (ACS-NSQIP).
  
  
  METHODS
  Inpatient and outpatient procedures in 374 hospitals of all types across the United States, 2005-12.
  
  
  METHODS
  2,305,380 adults who underwent surgical procedures.
  
  
  METHODS
  Arterial thrombosis (myocardial infarction or stroke) and venous thrombosis (deep venous thrombosis or pulmonary embolism) in the 30 days after surgery.
  
  
  RESULTS
  Among all surgical procedures, patients with preoperative systemic inflammatory response syndrome or any sepsis had three times the odds of having an arterial or venous postoperative thrombosis (odds ratio 3.1, 95% confidence interval 3.0 to 3.1). The adjusted odds ratios were 2.7 (2.5 to 2.8) for arterial thrombosis and 3.3 (3.2 to 3.4) for venous thrombosis. The adjusted odds ratios for thrombosis were 2.5 (2.4 to 2.6) in patients with systemic inflammatory response syndrome, 3.3 (3.1 to 3.4) in patients with sepsis, and 5.7 (5.4 to 6.1) in patients with severe sepsis, compared with patients without any systemic inflammation. In patients with preoperative sepsis, both emergency and elective surgical procedures had a twofold increased odds of thrombosis.
  
  
  CONCLUSIONS
  Preoperative sepsis represents an important independent risk factor for both arterial and venous thromboses. The risk of thrombosis increases with the severity of the inflammatory response and is higher in both emergent and elective surgical procedures. Suspicion of thrombosis should be higher in patients with sepsis who undergo surgery.
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, 3010 Bern, Switzerland Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 02120 Boston, Massachusetts, USA Harvard Medical School, 02115 Boston, Massachusetts, USA donze.author@gmail.com.
authors.forename: Jacques D
authors.initials: JD
authors.lastname: Donzé
authors.affiliation: Harvard Medical School, 02115 Boston, Massachusetts, USA Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women's Hospital, 02215 Boston, MA Division of Cardiovascular Medicine, Brigham and Women's Hospital, 02215 Boston, MA, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ridker
authors.affiliation: Department of Surgery, University of Utah, 84132 Salt Lake City, UT, USA.
authors.forename: Samuel R G
authors.initials: SR
authors.lastname: Finlayson
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 02120 Boston, Massachusetts, USA Harvard Medical School, 02115 Boston, Massachusetts, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000453:epidemiology*; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*; D018746:Systemic Inflammatory Response Syndrome / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology*; D055815:Young Adult