Prolonged operating room time in emergency general surgery is associated with venous thromboembolic complications

Joseph V Sakran; Hiba Ezzeddine; Elliott R Haut; Nicole Lunardi; Ambar Mehta; Rachel L Choron; Jennifer Reid; Muhammad Zeeshan; Mohammad Hamidi; Bellal A Joseph

doi:10.1016/j.amjsurg.2019.04.022

Prolonged operating room time in emergency general surgery is associated with venous thromboembolic complications

Am J Surg. 2019 Nov;218(5):836-841. doi: 10.1016/j.amjsurg.2019.04.022. Epub 2019 May 6.

Authors

Affiliations

¹ Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. Electronic address: jsakran1@jhmi.edu.
² Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
³ School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Surgery, NewYork-Presbyterian Columbia University Medical Center, New York, NY, USA.
⁵ Department of Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
⁶ Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.

PMID: 31088627
DOI: 10.1016/j.amjsurg.2019.04.022

Abstract

Background: We evaluated the association between operating room time and developing a deep vein thrombosis (DVT) or pulmonary embolus (PE) after emergency general surgery (EGS).

Methods: We reviewed six common EGS procedures in the 2013-2015 NSQIP dataset. After tabulating their incidence of postoperative VTE events, we calculated predictors of developing a VTE using adjusted multivariate logistic regressions.

Results: Of 108,954 EGS patients, 1,366 patients (1.3%) developed a VTE postoperatively. The median time to diagnosis was 9 days [5-16] for DVTs and 8 days [5-16] for PEs. Operating room time of 100 min or more was associated with increased risk of developing a DVT (OR 1.30 [1.12-2.21]) and PE (OR:1.25 [1.11-2.43]) with a 7% and 5% respective increase for every 10 min increase after the 100 min. Other independent predictors of VTE complications were older age, and history of cancer, and emergent colectomies on procedure-level analysis.

Conclusion: Prolonged operating room time is independently associated with increased risk of developing VTE complications after an EGS procedure. Most of the VTE complications were delayed in presentation.

Keywords: Deep venous thrombosis; Emergency general surgery; Prolonged operative time; Pulmonary embolism; Venous thromboembolism.

MeSH terms

Adult
Aged
Emergencies
Female
General Surgery*
Humans
Logistic Models
Male
Middle Aged
Operative Time*
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology
Postoperative Complications / etiology*
Pulmonary Embolism / diagnosis
Pulmonary Embolism / epidemiology
Pulmonary Embolism / etiology*
Retrospective Studies
Risk Factors
Venous Thromboembolism / diagnosis
Venous Thromboembolism / epidemiology
Venous Thromboembolism / etiology*
Venous Thrombosis / diagnosis
Venous Thrombosis / epidemiology
Venous Thrombosis / etiology*