The association between surgical duration and venous thromboembolism in outpatient surgery: A propensity score adjusted prospective cohort study

Abstract

Background Outpatient surgeries account for 60–70% of all procedures. Increased surgical duration has been demonstrated to be an independent risk factor for the development of venous thromboembolism (VTEs) after inpatient surgeries. In contrast, it is currently unknown if surgical duration increases the risk of VTEs for outpatient surgeries. Materials and methods The 2005 through 2016 NSQIP Participant Use Data Files were queried to extract all patients scheduled for outpatient surgery. A z-score for surgical duration was calculated for each procedure to allow for standardization across surgeries of expected shorter or longer duration. The primary outcome measured was incidence of VTEs within 30 days of surgery. Results A total of 3474 patients out of 1,863,523 (0.19%) had a VTE. After adjusting for confounding factors, the first and fifth quintiles compared to the middle quintile had odds ratios (ORs) of 0.75 (95% CI 0.68, 0.80) and 1.43 (95% CI, 1.35%–1.52%), respectively, P < 0.001. Patients who developed VTEs were more likely to be readmitted to the hospital, OR (95%CI) of 51.9 (48.0–56.2), C statistic = 0.67. Conclusion Surgical duration is associated with the development of VTEs after outpatient surgery. While the overall incidence of VTE is low and does not require generalized prophylaxis, clinical practitioners should consider prophylaxis for patients undergoing outpatient surgery performed with excessive time compared to the average surgical procedure duration.

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

“…Data from >1.8 million outpatient surgeries in the United States between 2005 and 2016 found an incidence of 0.19% postoperative VTE. 4 As expected, vascular interventions showed higher VTE rates after surgery (0.85%).…”

Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

“…The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996 and the ACS NSQIP Hospital Participation Agreement. The ACS NSQIP and the hospitals participating in this program are the sources of the data used in this study; however, these entities have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors [ 12 , 13 ].…”

“…Cases involving trauma, fracture, neoplasms, infectious diseases, or patients under 18 were excluded. Patients who qualified for the study under these criteria were then further stratified to an outpatient TKA cohort, defined as length of stay (LOS) of 0 days [ 13 ].…”

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Reduction of Venous Thromboembolic Disease in Colorectal Surgery

“…The risk of VTE in ambulatory surgery was investigated in a large NSQIP study of nearly 2 million patients who underwent outpatient procedures. 69 The overall rate of VTE was 0.19%, and the rate of VTE increased with a longer surgical duration.…”