Venous thromboembolism in patients undergoing surgery: Low rates of prophylaxis and high rates of filter insertion
Ali Seddighzadeh1, Urszula Zurawska2, Ranjith Shetty1, Samuel Z. Goldhaber1
1Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA; 2University of Western Ontario, London, Ontario, Canada
pulmonary embolism, prophylaxis, General surgery, postoperative deep vein thrombosis, inferior vena caval filters
Patients who undergo surgery are at a high risk of developing venous thromboembolism (VTE). To further define the demographics, comorbidities,and risk factors ofVTE in patients undergoing major surgery, we analyzed 1,375 hospitalized non-orthopedic surgery patients in a prospective registry of 5,451 patients with ultrasound confirmed deep vein thrombosis (DVT) from 183 hospitals in the United States. Extremity edema (67.9%), extremity discomfort (44.9%), and dyspnea (18.9%) were among the most common presenting symptoms among these surgical patients. Compared to medical patients, surgical patients presented with a more occult clinical picture and complained less often of extremity edema (67.9% vs. 73.7%; p=0.0001), extremity discomfort (44.9% vs. 56.4%; p<0.0001), or difficulty walking (6.6% vs. 11.2%; p<0.0001). Immobility within 30 days of DVT diagnosis, prior hospitalization within 30 days of DVT diagnosis, presence of an indwelling central venous catheter, obesity (BMI >30 kg/m2), and previous smoking were the most commonVTE risk factors among surgical patients. Among surgical patients who developed DVT,some form of prophylaxis had been used in only 44%. Once diagnosed with DVT, surgical patients received IVC filters more often than medical patients (20.0% vs. 14.1%; p<0.0001; adjusted OR=1.49, 95% CI=1.17–1.92; p<0.001). In conclusion,VTE prophylaxis remains underutilized in surgical patients. The IVC filter utilization rate in surgical patients is significantly higher than in medical patients. Future studies should focus on devising mechanisms to improve implementation of prophylaxis and investigate the long-term safety and efficacy of IVC filters in surgical patients.