Impact of sepsis on risk of postoperative arterial and venous thromboses: large prospective cohort study

Donzé, Jacques; Ridker, Paul M; Finlayson, Samuel R G; Bates, David W (2014). Impact of sepsis on risk of postoperative arterial and venous thromboses: large prospective cohort study. BMJ, 349, g5334. BMJ Publishing Group 10.1136/bmj.g5334

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OBJECTIVES To evaluate the impact of preoperative sepsis on risk of postoperative arterial and venous thromboses. DESIGN Prospective cohort study using the National Surgical Quality Improvement Program database of the American College of Surgeons (ACS-NSQIP). SETTING Inpatient and outpatient procedures in 374 hospitals of all types across the United States, 2005-12. PARTICIPANTS 2,305,380 adults who underwent surgical procedures. MAIN OUTCOME MEASURES Arterial thrombosis (myocardial infarction or stroke) and venous thrombosis (deep venous thrombosis or pulmonary embolism) in the 30 days after surgery. RESULTS Among all surgical procedures, patients with preoperative systemic inflammatory response syndrome or any sepsis had three times the odds of having an arterial or venous postoperative thrombosis (odds ratio 3.1, 95% confidence interval 3.0 to 3.1). The adjusted odds ratios were 2.7 (2.5 to 2.8) for arterial thrombosis and 3.3 (3.2 to 3.4) for venous thrombosis. The adjusted odds ratios for thrombosis were 2.5 (2.4 to 2.6) in patients with systemic inflammatory response syndrome, 3.3 (3.1 to 3.4) in patients with sepsis, and 5.7 (5.4 to 6.1) in patients with severe sepsis, compared with patients without any systemic inflammation. In patients with preoperative sepsis, both emergency and elective surgical procedures had a twofold increased odds of thrombosis. CONCLUSIONS Preoperative sepsis represents an important independent risk factor for both arterial and venous thromboses. The risk of thrombosis increases with the severity of the inflammatory response and is higher in both emergent and elective surgical procedures. Suspicion of thrombosis should be higher in patients with sepsis who undergo surgery.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Donzé, Jacques

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1756-1833

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Patricia Rajaonina

Date Deposited:

02 Apr 2015 16:25

Last Modified:

28 Oct 2016 12:40

Publisher DOI:

10.1136/bmj.g5334

PubMed ID:

25199629

BORIS DOI:

10.7892/boris.66055

URI:

https://boris.unibe.ch/id/eprint/66055

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