Q. Hatch1, D. Nelson1, J. Maykel3, E. Johnson1, B. Champagne2, N. Hyman4, S. Steele1 1Madigan Army Medical Center,Surgery,Tacoma, WA, USA 2Case Western Reserve University School Of Medicine,Cleveland, OH, USA 3University Of Massachusetts Medical School,Worcester, MA, USA 4University Of Chicago,Chicago, IL, USA
Introduction: Little data exists regarding the impact of perioperative sepsis on deep venous thrombosis (DVT) rates in colorectal surgery patients. We sought to quantify the current rate of 30-day DVT in colorectal surgery patients, and hypothesized perioperative sepsis increased the DVT rate in this patient population.
Methods: CPT codes were used to identify patients who underwent major colon or rectal surgery as reported to the National Surgical Quality Improvement Program (NSQIP) in 2010. Patients were stratified by the presence or absence of DVT in the perioperative period, and cohorts were compared in terms of demographics, comorbidities, and the presence of sepsis. Sepsis was defined by specially-trained NSQIP data collectors using Systemic Inflammatory Response Syndrome criteria with an identified infectious source.
Results: Of the 26,554 patients who underwent a major colorectal operation, 462 (1.7%) developed a deep venous thrombosis. Older patients (66 years vs. 61 years), open (77% vs. 23%) or emergency (31% vs. 15%) surgery, chronic steroid use (11% vs. 7%), and perioperative systemic sepsis (39% vs. 13%) were more likely to develop a DVT (P<0.01). Current smokers and patients undergoing major rectal surgery were less likely to develop DVT (P≤0.02). On multivariate logistic regression analysis (controlling for ASA score, age, major rectal surgery, open surgery, length of hospital stay, smoking, and emergency surgery), systemic sepsis was independently associated with higher rates of DVT (OR=2.6, 95% CI 2.0-3.3, P<0.001).
Conclusion: Perioperative sepsis is a significant risk factor for post-operative deep venous thrombosis in the colorectal surgery population. Increased vigilance for DVT is warranted in patients who experience infectious complications after colorectal surgery.