Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis

Faisal Aziz, Erik Lehman, John Blebea, Fedor Lurie

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods: The American College of Surgeons’ NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results: A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29–22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12–38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79–30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27–6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37–7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03–10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54–8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66–29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27–25.73, p < 0.01). Presence of all three factors was associated with a 54% incidence of deep venous thrombosis. Conclusions: Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested.

Original languageEnglish (US)
Pages (from-to)558-566
Number of pages9
JournalPhlebology
Volume33
Issue number8
DOIs
StatePublished - Sep 1 2018

Fingerprint

Venous Thrombosis
Lower Extremity
Odds Ratio
Confidence Intervals
Peripheral Arterial Disease
Reoperation
Urinary Tract Infections
Physiologic Monitoring
Wound Infection
Operating Rooms
Urinary Tract
Statistical Factor Analysis
Erythrocytes
Logistic Models
Regression Analysis
Databases
Hemorrhage
Incidence

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Aziz, Faisal ; Lehman, Erik ; Blebea, John ; Lurie, Fedor. / Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis. In: Phlebology. 2018 ; Vol. 33, No. 8. pp. 558-566.
@article{02bee5b955f24b869b08dda4c5fad4ef,
title = "Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis",
abstract = "Background: Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods: The American College of Surgeons’ NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results: A total of 2646 patients (65{\%} males and 35{\%} females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29–22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12–38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79–30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27–6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37–7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03–10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54–8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66–29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27–25.73, p < 0.01). Presence of all three factors was associated with a 54{\%} incidence of deep venous thrombosis. Conclusions: Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested.",
author = "Faisal Aziz and Erik Lehman and John Blebea and Fedor Lurie",
year = "2018",
month = "9",
day = "1",
doi = "10.1177/0268355517737455",
language = "English (US)",
volume = "33",
pages = "558--566",
journal = "Phlebology",
issn = "1433-3031",
publisher = "SAGE Publications Ltd",
number = "8",

}

Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis. / Aziz, Faisal; Lehman, Erik; Blebea, John; Lurie, Fedor.

In: Phlebology, Vol. 33, No. 8, 01.09.2018, p. 558-566.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Postoperative complications after lower extremity arterial bypass increase the risk of new deep venous thrombosis

AU - Aziz, Faisal

AU - Lehman, Erik

AU - Blebea, John

AU - Lurie, Fedor

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods: The American College of Surgeons’ NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results: A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29–22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12–38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79–30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27–6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37–7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03–10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54–8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66–29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27–25.73, p < 0.01). Presence of all three factors was associated with a 54% incidence of deep venous thrombosis. Conclusions: Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested.

AB - Background: Deep venous thrombosis after any surgical operations is considered a preventable complication. Lower extremity bypass surgery is a commonly performed operation to improve blood flow to lower extremities in patients with severe peripheral arterial disease. Despite advances in endovascular surgery, lower extremity arterial bypass remains the gold standard treatment for severe, symptomatic peripheral arterial disease. The purpose of this study is to identify the clinical risk factors associated with development of deep venous thrombosis after lower extremity bypass surgery. Methods: The American College of Surgeons’ NSQIP database was utilized and all lower extremity bypass procedures performed in 2013 were examined. Patient and procedural characteristics were evaluated. Univariate and multivariate logistic regression analysis was used to determine independent risk factors for the development of postoperative deep venous thrombosis. Results: A total of 2646 patients (65% males and 35% females) underwent lower extremity open revascularization during the year 2013. The following factors were found to be significantly associated with postoperative deep venous thrombosis: transfusion >4 units of packed red blood cells (odds ratio (OR) = 5.21, confidence interval (CI) = 1.29–22.81, p = 0.03), postoperative urinary tract infection (OR = 12.59, CI = 4.12–38.48, p < 0.01), length of hospital stay >28 days (OR = 9.30, CI = 2.79–30.92, p < 0.01), bleeding (OR = 2.93, CI = 1.27–6.73, p = 0.01), deep wound infection (OR = 3.21, CI = 1.37–7.56, p < 0.01), and unplanned reoperation (OR = 4.57, CI = 2.03–10.26, p < 0.01). Of these, multivariable analysis identified the factors independently associated with development of deep venous thrombosis after lower extremity bypass surgery to be unplanned reoperation (OR = 3.57, CI = 1.54–8.30, p < 0.01), reintubation (OR = 8.93, CI = 2.66–29.97, p < 0.01), and urinary tract infection (OR = 7.64, CI = 2.27–25.73, p < 0.01). Presence of all three factors was associated with a 54% incidence of deep venous thrombosis. Conclusions: Development of deep venous thrombosis after lower extremity bypass is a serious but infrequent complication. Patients who require unplanned return to the operating room, reintubation, or develop a postoperative urinary tract are at high risk for developing postoperative deep venous thrombosis. Increased monitoring of these patients and ensuring adequate deep venous thrombosis prophylaxis for such patients is suggested.

UR - http://www.scopus.com/inward/record.url?scp=85041900192&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041900192&partnerID=8YFLogxK

U2 - 10.1177/0268355517737455

DO - 10.1177/0268355517737455

M3 - Article

VL - 33

SP - 558

EP - 566

JO - Phlebology

JF - Phlebology

SN - 1433-3031

IS - 8

ER -