Venous thromboembolism in emergency general surgery patients: a single-centre retrospective cohort study

Abstract

Background: There is limited literature on the risk of venous thromboembolism (VTE) in emergency general surgery (EGS) patients. We undertook this study to identify the rate of symptomatic VTE for patients undergoing EGS operations. Methods: We conducted a retrospective cohort study evaluating EGS patients who underwent operative intervention between March and December 2014. Data collected included patient demographics, type of procedure, risk of VTE, VTE prophylaxis, development of symptomatic VTE, and mortality. Results: We included 767 patients in our analysis. The mean age was 53 ± 19.7 years, and 52.2% of patients were female. Eighteen patients (2.3%) experienced VTE in hospital and 12 (1.6%) experienced VTE after discharge. Only 66% of patients received appropriate VTE prophylaxis. High-risk patients had a higher VTE rate (7.4% v. 2.3%, p < 0.001) and higher mortality (17.6% v. 4.0%, p < 0.001) than lowto moderate-risk patients. Conclusion: The risk of VTE in patients requiring EGS is significant and persists after hospital discharge. Further studies on quality improvement with VTE prophylaxis are warranted. Contexte : La littérature sur le risque de thromboembolie veineuse (TEV) chez les patients soumis à une chirurgie générale urgente est limitée. Nous avons entrepris cette étude afin de mesurer le taux de TEV symptomatique chez les patients ayant subi une intervention urgente en chirurgie générale. Méthodes : Nous avons procédé à une étude de cohorte rétrospective sur les patients qui ont subi une chirurgie générale urgente entre mars et décembre 2014. Parmi les données recueillies, mentionnons données démographiques, type d'intervention, risque de TEV, thromboprophylaxie, apparition d'une TEV symptomatique et mortalité. Résultats : Nous avons inclus 767 patients dans notre analyse. L'âge moyen était de 53 ± 19,7 ans et 52,2 % des patients étaient de sexe féminin. Dix-huit patients (2,3 %) ont présenté une TEV en cours d'hospitalisation et 12 (1,6 %) après leur congé. Seulement 66 % des patients ont reçu une thromboprophylaxie adéquate. Les patients à haut risque ont présenté des taux de TEV (7,4 % c. 2,3 %, p < 0,001) et de mortalité (17,6 % c. 4,0 %, p < 0,001) plus élevés que les patients présentant un risque faible à modéré. Conclusion : Le risque de TEV chez les patients soumis à une chirurgie générale urgente est significatif et persiste après le congé hospitalier. Il faudra mener des études plus approfondies sur l'amélioration de la qualité de la thromboprophylaxie.

Venous Thromboembolism Chemoprophylaxis in Trauma and Emergency General Surgery Patients: A Systematic Review

“…Yang et al (2020) evaluated VTE incidence in 767 EGS patients where only 66% of patients received appropriate chemoprophylaxis in less than 24 hr of admission and concluded that higher-risk patients (Caprini score of ≥5 points) demonstrated a significantly higher VTE rate (7.4% vs. 2.3%, p < .001) and significantly higher mortality (17.6% vs. 4.0%, p < .001) compared with low/moderate-risk patients.…”

“…In EGS patients, high-risk patients with a Caprini score of 5 or more points were associated with a significantly higher VTE incidence and associated mortality (Yang et al, 2020). Creating and following guidelines have been correlated with improved VTE chemoprophylaxis (Kreckler et al, 2013; McCulloch et al, 2010; McKenna et al, 2009; Stevenson et al, 2007).…”

“…However, there was no statistically significant difference for DVT or PE rates between the two agents. Yang et al (2020) evaluated VTE incidence in 767 EGS patients where only 66% of patients received appropriate chemoprophylaxis in less than 24 hr of admission and concluded that higher-risk patients (Caprini score of ≥5 points) demonstrated a significantly higher VTE rate (7.4% vs. 2.3%, p < .001) and significantly higher mortality (17.6% vs. 4.0%, p < .001) compared with low/ moderate-risk patients. Balachandran et al (2020) evaluated the efficacy of VTE chemoprophylaxis in 1,179 EGS patients where VTE incidence was compared between patients receiving 2,500 or 5,000 IU of dalteparin daily and found that higher doses were associated with an increased risk of complications (p < .001) and VTE incidence (p = .027).…”

Venous Thromboembolism in Emergency General Surgery Patients—A Call to Action to Improve Data, Clinical Care, and Patient Outcomes

“…This work, like most good research, raises more questions than it answers. 1 How can we change the above-average VTE rate 7 in the EGS population? What should be our targets for improvements?…”