Surgical Duration and Risk of Venous Thromboembolism | Health Care Safety | JAMA Surgery | JAMA Network
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Original Investigation
February 2015

Surgical Duration and Risk of Venous Thromboembolism

Author Affiliations
  • 1Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
  • 2Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Surg. 2015;150(2):110-117. doi:10.1001/jamasurg.2014.1841
Abstract

Importance  There is a paucity of data assessing the effect of increased surgical duration on the incidence of venous thromboembolism (VTE).

Objective  To examine the association between surgical duration and the incidence of VTE.

Design, Settings, and Participants  Retrospective cohort of 1 432 855 patients undergoing surgery under general anesthesia at 315 US hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2011.

Exposure  Duration of surgery.

Main Outcomes and Measures  The rates of deep vein thrombosis (DVT), pulmonary embolism (PE), and VTE within 30 days of the index operation. Surgical duration was standardized across Current Procedural Terminology codes using a z score. Outcomes were compared across quintiles of the z score. Multiple logistic regression models were developed to examine the association while adjusting for patient demographics, clinical characteristics, and comorbidities.

Results  The overall VTE rate was 0.96% (n = 13 809); the rates of DVT and PE were 0.71% (n = 10 198) and 0.33% (n = 4772), respectively. The association between surgical duration and VTE increased in a stepwise fashion. Compared with a procedure of average duration, patients undergoing the longest procedures experienced a 1.27-fold (95% CI, 1.21-1.34; adjusted risk difference [ARD], 0.23%) increase in the odds of developing a VTE; the shortest procedures demonstrated an odds ratio of 0.86 (95% CI, 0.83-0.88; ARD, −0.12%). The robustness of these results was substantiated with several sensitivity analyses attempting to minimize the effect of outliers, concurrent complications, procedural differences, and unmeasured confounding variables.

Conclusions and Relevance  Among patients undergoing surgery, an increase in surgical duration was directly associated with an increase in the risk for VTE. These findings may help inform preoperative and postoperative decision making related to surgery.

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