Abstract
Background Venous thromboembolism (VTE) is a common vascular complication of noncardiac surgery.
Methods We evaluated national trends in perioperative in-hospital VTE incidence, management,
and outcomes using a large database of hospital admissions from the United States.
Patients aged ≥ 45 years undergoing major noncardiac surgery from 2005 to 2013 were
identified from the National Inpatient Sample. In-hospital perioperative VTE was defined
as lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE), and the
incidence was evaluated over time. Multivariable regression models with demographics
and comorbidities as covariates were generated to estimate adjusted odds ratios (aOR).
Results Major noncardiac surgery was performed in 9,431,442 hospitalizations that met inclusion
criteria, and perioperative VTE occurred in 99,776 patients (1,057 per 100,000), corresponding
to an annual incidence of ≈53,000 after applying sample weights. Over time, perioperative
VTE per 100,000 surgeries increased by 135 (95% confidence interval [CI]: 107–163),
from 925 in 2005 to 1,060 in 2013 (p for trend <0.001; aOR [for 2013 vs. 2005]: 1.22, 95% CI: 1.19–1.26), due to increases
in nonfatal VTE rates (from 840 [per 100,000 surgeries] in 2005 to 987 in 2013; p for trend <0.001). Perioperative VTE occurred most frequently in patients undergoing
thoracic (2.0%) and vascular surgery (1.8%). Mortality was higher in patients with
VTE than those without VTE (aOR: 3.12, 95% CI: 3.05–3.20).
Conclusion Perioperative VTE occurs in approximately 1% of patients ≥45 years undergoing major
noncardiac surgery, with increasing incidence of nonfatal VTE over time.
Keywords
deep vein thrombosis - mortality - perioperative - pulmonary embolism - surgery -
venous thromboembolism
