Summary
Patients who undergo surgery are at a high risk of developing venous thromboembolism
(VTE). To further define the demographics, comorbidities, and risk factors of VTE
in patients undergoing major surgery, we analyzed 1,375 hospitalized non-orthopedic
surgery patients in a prospective registry of 5,451 patients with ultrasound confirmed
deep vein thrombosis (DVT) from 183 hospitals in the United States. Extremity edema
(67.9%), extremity discomfort (44.9%), and dyspnea (18.9%) were among the most common
presenting symptoms among these surgical patients. Compared to medical patients, surgical
patients presented with a more occult clinical picture and complained less often of
extremity edema (67.9% vs. 73.7%; p=0.0001), extremity discomfort (44.9% vs. 56.4%;
p<0.0001), or difficulty walking (6.6% vs. 11.2%; p<0.0001). Immobility within 30
days of DVT diagnosis, prior hospitalization within 30 days of DVT diagnosis, presence
of an indwelling central venous catheter, obesity (BMI >30 kg/m2), and previous smoking were the most common VTE risk factors among surgical patients.
Among surgical patients who developed DVT, some form of prophylaxis had been used
in only 44%. Once diagnosed with DVT, surgical patients received IVC filters more
often than medical patients (20.0% vs. 14.1%; p<0.0001; adjusted OR=1.49, 95% CI=1.17–1.92;
p<0.001). In conclusion, VTE prophylaxis remains underutilized in surgical patients.
The IVC filter utilization rate in surgical patients is significantly higher than
in medical patients. Future studies should focus on devising mechanisms to improve
implementation of prophylaxis and investigate the long-term safety and efficacy of
IVC filters in surgical patients.
Keywords
General surgery - prophylaxis - pulmonary embolism - postoperative deep vein thrombosis
- inferior vena caval filters
