Study identifies risk factors for PE and DVT after ambulatory surgery

Editor's Note

Pulmonary embolism (PE) and deep vein thrombosis (DVT) are rare after same-day surgeries, but when they occur, they carry high risks of death and readmission. According to Anesthesiology News May 12, a University of Texas Southwestern Medical Center analysis of more than 1.1 million outpatient procedures found an overall event rate of two per 1,000 operations, with most cases arising within 2 weeks of surgery.

As detailed in the article, investigators reviewed data from the 2017–2021 American College of Surgeons National Surgical Quality Improvement Program. Among 1,169,286 adult patients across 107 classes of procedures, 2,202 developed PE or DVT within 30 days. Median onset was 9 days postop, with 75% of cases occurring before day 16. Patients who suffered PE/DVT faced sharply worse outcomes. Readmission occurred in 38% of affected patients compared with 1.7% of unaffected patients, while 30-day mortality was 1.1% versus 0.6%. The odds of readmission were 35 times higher for patients with thrombotic events, and mortality risk was nearly 19 times greater.

Rates varied by specialty and procedure. Vascular surgery carried the highest risk (8.6 per 1,000), followed by orthopedics (3.3 per 1,000) and urology (2 per 1,000). Specific procedures with elevated rates included varicose vein treatment (17.3 per 1,000), lower-extremity endarterectomy (13.3 per 1,000), ACL repair (5.7 per 1,000), knee arthroplasty (5.6 per 1,000), and knee meniscectomy (5.5 per 1,000). Procedure type explained about 19% of the variability in risk.

Independent predictors of PE/DVT included older age, higher BMI, dyspnea, ascites, chronic steroid use, recent weight loss, longer surgical times, and specialty type. These findings, the outlet notes, suggest enhanced surveillance and prophylaxis should be considered after high-risk procedures, particularly knee and vascular surgeries of the lower extremities. The article highlights limitations of the dataset, including lack of information on whether patients received prophylactic drugs.