W. Royster1, V. Patel1, J. Nicastro1, G. Coppa1, M. Sfakianos1, G. Sugiyama1 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell,Department Of General Surgery,Manhasset, NY, USA
Introduction: Patients undergoing colorectal surgery are often at higher risk of developing deep vein thrombosis (DVT) postoperatively. We propose that preoperative sepsis for patients undergoing emergent colectomy is an independent risk factor for developing post operative DVT.
Methods: We analyzed the National Surgical Quality Improvement Program (NSQIP) Database for all patients who underwent open colectomies (CPT 44140, 44141, 44143, 44145, 44146, 44150, 44151, 44155, 44156, and 44160) between 2005 and 2013. Patients with known malignancy were excluded from this study, as this is a known risk factor for the development of DVTs. Patients were divided into those who presented with SIRS, sepsis or septic shock and those who did not. A Chi square analysis was used to assess the relationship between patients who were septic preoperatively and those who developed DVTs. Then, multivariate logistic regression was used to determine risk factors for the development of DVTs postoperatively.
Results: A total of 88,819 patients were included in this study. 46,626 (52.5%) were female. 66,394 (74.8%) were Caucasian. Patients age ranged from 16 – >89 years old. The majority of patients were age 60 or older (58.0%). A total of 2,517 (2.8%) developed DVTs postoperatively. Sepsis was identified in 16,875 patients (19.0%). Gender (p=0.153), BMI (p=0.143), and alcohol abuse (p=0.690) were not statistically significant risk factors. Patients who presented with sepsis were more likely to develop DVTs postoperatively (5.2% vs 2.3%, respectively p<0.001). In patients who underwent an open colectomy, the greatest risk factors for the development of a DVT were emergency surgery (OR=1.421, p<0.001), COPD (OR=1.307, p<0.001), pneumonia (OR=1.371, p=0.016), and sepsis(OR=1.867, p<0.001).
Conclusion: Patients who underwent colon surgery while septic were more likely to develop a DVT postoperatively. These patients should be selected for early and aggressive DVT prophylaxis in the peri and postoperative setting.