BMI and VTE Risk in Emergency General Surgery, Does Size Matter?

Abstract

Background Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality. Emergency general surgery (EGS) patients comprise 7% of hospital admissions in America with a reported rate of VTE of 2.5%. Of these, >69% required hospital readmission, making VTE the second most common cause for readmission after infection in EGS patients. We hypothesize a correlation between body mass index (BMI) and VTE in EGS patients. Methods The American College of Surgeons National Surgery Quality Improvement Database (NSQIP) was queried from January 2015 to December 2016. 83 272 patients met inclusion criteria: age ≥18 and underwent an EGS procedure. Patients were stratified by BMI. Descriptive statistics were used for demographic and numerical data. Categorical comparisons between covariates were completed using the chi-square test. Continuous variables were compared using Student’s t-test, Mann Whitney U-test, or Kruskal-Wallis H test. Results 83 272 patients met the inclusion criteria. 1358 patients developed VTE (903 deep vein thrombosis (DVT) only, 335 pulmonary embolism (PE) only, and 120 with DVT and PE). Morbidly obese patients were 1.7 times more likely to be diagnosed with a PE compared with normal BMI ( P = .004). Increased BMI was associated with the co-diagnosis of PE and DVT ( P = .027). Patients with BMI <18.5 were 1.4 times more likely to experience a VTE compared with normal BMI ( P = .018). Patients with a VTE were 3.2 times more likely to die ( P < .001) and less likely to be discharged home ( P < .001). Discussion Our study found that obese and underweight EGS patients had an increased incidence of VTE. Risk recognition and chemoprophylaxis may improve outcomes in this population.

Recommendations from the ICM-VTE: General

“…Increased BMI was also associated with the co-diagnosis of PE and deep venous thrombosis (DVT). In addition to this, patients with BMI < 18.5 Kg/m 2 or > 40 Kg/m 2 were 1.4 times more likely to experience a VTE compared with normal BMI patients 11 .…”

Body Mass Index (BMI) Related Morbidity with Thyroid Surgery

“…30 The correlation of increasing BMI with postoperative complication is not reported universally in surgery. Some evidence suggests there are increased rates of myocardial infarction, PE and DVT in sub-specialty surgery [60][61][62] whereas other large scale reviews have not echoed the same correlations. [63][64][65][66] The rates of complication are likely additionally confounded between surgical specialties by the fact that all receive general anesthesia.…”

Safety of DIEP Flap Reconstruction in Patients with Factor V Leiden: A Retrospective Cohort Study

“…Patients may also be counseled to improve modifiable factors such as smoking cessation, weight loss, and medication cessation. [22][23][24] The results of this study must be viewed within the context of the study design. The fact that not all patients in our cohort were tested for FVL mutations makes it likely that there were additional patients with undiagnosed FVL mutations who underwent free flap breast reconstruction in the control group.…”

“…Patients may also be counseled to improve modifiable factors such as smoking cessation, weight loss, and medication cessation. 22–24…”