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. 2014 Sep 8:349:g5334.
doi: 10.1136/bmj.g5334.

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

Jacques D Donzé  1 , Paul M Ridker  2 , Samuel R G Finlayson  3 , David W Bates  4
Affiliations

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

Jacques D Donzé et al. BMJ. .

Abstract

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.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; JD does consultancy for Profility and Homeward Health; PR is listed as a co-inventor on patents held by the Brigham and Women’s hospital that relate to the use of inflammatory biomarkers in cardiovascular disease and diabetes that have been licensed to Siemens and AstraZeneca, has received investigator initiated research grants from the National Institutes of Health, Amgen, Novartis, Pfizer, and AstraZeneca, and has served as a consultant to Vascular Biogenics, ISIS, Aegerion, Lilly, and BostonHeart. DB is a board member of SAE Medical, does consultancy for Zynx, and has received grants from Earlysense and received royalties from Medicalis.

Figures

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Fig 1 Flow of participants in study of impact of sepsis on risk of postoperative arterial and venous thromboses diagram
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Fig 2 Subgroup analysis for arterial thrombosis risk associated with preoperative sepsis. Arterial thrombosis includes acute myocardial infarction or stroke that occurred intraoperatively or within 30 days after surgical procedure. Odds ratios adjusted for age, sex, diabetes, smoking status, treated arterial hypertension, renal failure, cancer, bleeding disorder or anticoagulation, general anaesthesia, and surgical subspecialty
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Fig 3 Subgroup analysis for risk of venous thrombosis associated with preoperative sepsis. Venous thrombosis includes deep venous thrombosis or pulmonary embolism that occurred intraoperatively or within 30 days after surgical procedure. Odds ratios adjusted for age, sex, diabetes, smoking status, treated arterial hypertension, renal failure, cancer, bleeding disorder or anticoagulation, general anaesthesia, and surgical subspecialty
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