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Association of Neuraxial Anesthesia With Postoperative Venous Thromboembolism After Noncardiac Surgery: A Propensity-Matched Analysis of ACS-NSQIP Database

Turan, Alparslan MD*,†; Bajracharya, Gausan R. MD*; Leung, Steve MD*; Yazici Kara, Merve MD*; Mao, Guangmei PhD*,‡; Botsford, Thomas MD§; Ruetzler, Kurt MD*,†; Maheshwari, Kamal MD, MPH*,‡; Ali Sakr Esa, Wael MD, PhD*,‡; Elsharkawy, Hesham MD, MBA, MSc*,‡; Sessler, Daniel I. MD*

doi: 10.1213/ANE.0000000000003394
Patient Safety: Original Clinical Research Report

BACKGROUND: Neuraxial anesthesia improves components of the Virchow’s triad (hypercoagulability, venous stasis, and endothelial injury) which are key pathogenic contributors to venous thrombosis in surgical patients. However, whether neuraxial anesthesia reduces the incidence of venous thromboembolism (VTE) remain unclear. We therefore tested the primary hypothesis that neuraxial anesthesia reduces the incidence of 30-day VTE in adults recovering from orthopedic surgery. Secondarily, we tested the hypotheses that neuraxial anesthesia reduces 30-day readmission, 30-day mortality, and the duration of postoperative hospitalization.

METHODS: Inpatient orthopedic surgeries from American College of Surgeons National Surgical Quality Improvement Program database (2011–2015) in adults lasting more than 1 hour with either neuraxial or general anesthesia were included. Groups were matched 1:1 by propensity score matching for appropriate confounders. Logistic regression model was used to assess the effect of neuraxial anesthesia on 30-day VTE, 30-day mortality, and readmission, while Cox proportional hazard regression model was used to assess its effect on length of stay.

RESULTS: Neuraxial anesthesia decreased odds of 30-day VTE (odds ratio 0.85, 95% confidence interval, 0.78–0.95; P = .002) corresponding to number-needed-to-treat of 500. Although there was no difference in 30-day mortality, neuraxial anesthesia reduced 30-day readmission (odds ratio 0.90, 98.3% confidence interval, 0.85–0.95; P < .001) corresponding to number-needed-to-treat of 250 and had a shortened hospitalization (2.87 vs 3.11; P < .001).

CONCLUSIONS: Neuraxial anesthesia appears to provide only weak VTE prophylaxis, but can be offered as an adjuvant to current thromboprophylaxis in high-risk patients.

From the *Department of Outcomes Research, Anesthesiology Institute

Departments of General Anesthesia, Anesthesiology Institute

Departments of Quantitative Health Science

§Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.

Published ahead of print 14 March 2018.

Accepted for publication March 14, 2018.

Funding: Internal.

The authors declare no conflicts of interest.

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Reprints will not be available from the authors.

Address correspondence to Alparslan Turan, MD, Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, P-77, Cleveland, OH 44195. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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