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Preoperative Hospitalization Is Independently Associated With Increased Risk for Venous Thromboembolism in Patients Undergoing Colorectal Surgery: A National Surgical Quality Improvement Program Database Study

Greaves, Spencer W. M.P.H.1,2; Holubar, Stefan D. M.D., M.S.1,3

Diseases of the Colon & Rectum: August 2015 - Volume 58 - Issue 8 - p 782–791
doi: 10.1097/DCR.0000000000000411
Original Contributions

BACKGROUND: An important factor in the pathophysiology of venous thromboembolism is blood stasis, thus, preoperative hospitalization length of stay may be contributory to risk.

OBJECTIVE: We assessed preoperative hospital length of stay as a risk factor for venous thromboembolism.

DESIGN: We performed a retrospective review of patients who underwent colorectal operations using univariate and multivariable propensity score analyses.

SETTINGS: This study was conducted at a tertiary referral hospital.

PATIENTS: Data on patients was obtained from the American College of Surgeons National Surgical Quality Improvement Program 2005–2011 Participant Use Data Files.

MAIN OUTCOME MEASURES: Short-term (30-day) postoperative venous thromboembolism was measured.

RESULTS: Our analysis included 242,670 patients undergoing colorectal surgery (mean age, 60 years; 52.9% women); of these, 72,219 (29.9%) were hospitalized preoperatively. The overall rate of venous thromboembolism was 2.07% (1.4% deep vein thrombosis, 0.5% pulmonary embolism, and 0.2% both). On multivariable analysis, the most predictive independent risk factors for venous thromboembolism were return to the operating room (OR, 1.62 (95% CI, 1.44–1.81); p < 0.001) and chronic steroid use (OR, 1.59 (95% CI, 1.41–1.80); p < 0.001); preoperative hospitalization also independently predicted venous thromboembolism (OR, 1.39 (95% CI, 1.28–1.51); p < 0.001), whereas the use of laparoscopy was protective (OR, 0.75 (95% CI, 0.67–0.83); p < 0.001). Propensity score stratification (capped at 7 days, 100 strata, area under the curve = 0.73) indicated that each day of preoperative hospitalization increased the odds of venous thromboembolism (OR, 1.42 (95% CI, 1.32–1.53); p < 0.001). All of the analyses showed a dose-response relationship between preoperative lengths of stay and risk of postoperative venous thromboembolism (p < 0.001). Patients who experienced venous thromboembolism had a higher 30-day mortality rate (3.7% vs 8.9%; p < 0.001).

LIMITATIONS: This study has limited potential generalizability and a retrospective design.

CONCLUSIONS: Preoperative hospitalization is an independent risk factor for venous thromboembolism and its associated increase in mortality after colorectal surgery, whereas laparoscopy is a strong protective variable. Further research into preoperative screening for highest-risk patients is indicated.

1 Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire

2 Medical College of Wisconsin, Milwaukee, Wisconsin

3 Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Financial Disclosure: None reported.

Podium presentation at the meeting of the New England Society of Colon & Rectal Surgery, Woodstock, VT, June 1, 2013 and the meeting of The American Society of Colon and Rectal Surgeons, Hollywood, FL, May 17 to 21, 2014.

Correspondence: Stefan D. Holubar, M.D., M.S., One Medical Center Dr, Lebanon, NH 03756. E-mail:

© 2015 The American Society of Colon and Rectal Surgeons