COMPARATIVE STUDY ON THE IMPACT OF SURGICAL RISK FACTORS IN PATIENTS WITH VENOUS THROMBOEMBOLISM. ANALYSIS OF THE MORTALITY RISK

Background: Accurate and immediate diagnosis of venous thromboembolism (VTE) still remains a difficult challenge for clinicians. Because of the increasing awareness of postoperative VTE, selection of patients who require adequate prophylaxis is of primary importance. Without prophylaxis, the incidence of hospital-acquired deep vein thrombosis (DVT) is approximately 10-40% among surgical patients and 40-60% following major orthopedic surgery. Pulmonary embolism (APE) is a life threatening disease and one of the main causes of in-hospital mortality. Aim:The purpose of this study was to determine the relationship between surgical risk factors and VTE and in-hospital mortality in patients with APE. Methods: We conducted a prospective, cohort study, between January 2004 and December 2010. The patients with VTE, admitted in the Ist Medical Cardiology Clinic, in “St Spiridon” University Hospital, Iasi were included. The risk factors analised were: postoperative risk factor in orthopedic surgery, major surgery and gynecologic surgery and additional risk factors: obesity, central venous line, imobilization and neoplasia. To evaluate which risk factors were independent predictors of mortality in VTE, potential confounding variables were chosen using univariate analysis (p < 0.10), and final odds ratio (OR) and 95% confidence interval (CI) were calculated using multiple logistic regression analysis. Results: The cohort consisted of 890 subjects with VTE: 362 with EP and 528 with DVT. The mortality was 21.54% (78 subjects died). From surgical risk factors, orthopedic surgery was most common (5.8% in PE and 6.4% in DVT), followed by general surgery (2.3% in EP and 3.4%DVT) and gynecologic surgery (0.82% in EP patients, 1.13% in DVT). Multivariate analysis showed that an obesity (OR=4.21, CI=2.08-8.53, p=0.0001), imobilisation (OR=3.34, CI=1.18-9.45, p=0,023) and time between admission and death (OR=0.77, CI=0.72-0.83, p<0,0001) were the only significant predictors of mortality VTE. Conclusions: Mortality in patients with VTE and surgical risk factors is high and preoperative screening is important to identify patients at risk of developing clinically significant thromboembolic events.