J. K. Aboagye1, J. W. Hayanga4, B. D. Lau1, D. Shaffer1, P. Kraus2, D. Hobson1, M. Streiff3, J. D’Cuhna4, E. R. Haut1,5 1Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA 2Johns Hopkins School Of Medicine,Pharmacy,Baltimore, MD, USA 3Johns Hopkins University School Of Medicine,Hematology,Baltimore, MD, USA 4University Of Pittsburgh Medical Center,Cardiothoracic Surgery,Pittsburgh, PA, USA 5Johns Hopkins Bloomberg School Of Public Health,Health Policy,Baltimore, MD, USA
Introduction:
Previous studies on the incidence of and risk factors for venous thromboembolism (VTE) following lung transplantation (LT) were largely limited to single centers, hence limiting their generalizability. The purpose of this study was to estimate the incidence of VTE, identify risk factors associated with VTE post LT using a nationally representative sample of patients. We also aimed to determine the impact of VTE following LT on in-hospital mortality, length of hospitalization and cost.
Methods:
We retrospectively examined the National Inpatient Sample database to identify patients who had undergone LT from 2000 to 2011. We calculated the incidence of VTE and predictors of VTE following LT. In multivariate analyses we estimated the association between VTE and in-hospital mortality, length of hospitalization and total hospital cost.
Results:
A total of 16,318 adult lung transplant recipients underwent LT during the study period. Of these 1029 (6.3%) developed VTE post-operatively. This comprised of 854 (5.4%) and 175 (1.1%) who developed only deep vein thrombosis and pulmonary embolism respectively. The predictors of VTE in this cohort included age greater than 60 years, (OR 1.37 95% CI 1.02-1.85), female gender, (OR 0.61 95% CI 0.45-0.84) receiving mechanical ventilation support (OR 2.35 95% CI 1.77- 3.13) and receiving extracorporeal membrane oxygenation support 1.75 95% CI (1.05-2.91). The adjusted odds of in-hospital mortality in LT recipients who had VTE was twice as much as their counterparts who did not. (OR 1.89 95% CI 1.17-3.06). On the average, the length of hospitalization and total cost of hospitalization were 46% (95% CI 33-58) and 29% (95% CI 21-36) higher for LT patients who developed VTE compared with those who did not after adjusting for confounders.
Conclusion:
VTE is a frequent complication after lung transplantation with an associated odds of increased mortality, total hospital length of stay and cost. There is the need to reexamine prophylaxis practices in these patients to address this complication.