Key result
Outpatient surgeries in the longest duration quintile were associated with a 1.43-fold increased odds of developing venous thromboembolism within 30 days compared to procedures of average duration.
Why the study?
Although increased surgical duration is an independent risk factor for venous thromboembolism after inpatient surgery, whether it increases risk in outpatient surgeries was unknown.
Does increased surgical duration increase the risk of venous thromboembolism in patients undergoing outpatient surgery?
Cohort (n=1,863,523)
Yes
Does increased surgical duration increase the risk of venous thromboembolism in patients undergoing outpatient surgery?
Effect estimate: OR 1.43 (95% CI 1.35-1.52)
Absolute Event Rate: 0.27% vs 0.17%
p-value: p=<0.001
Increased surgical duration in outpatient procedures is associated with a higher risk of developing venous thromboembolism within 30 days, suggesting a potential need for prophylaxis in prolonged surgeries.
May support VTE risk stratification for longest outpatient cases; leaves open whether prophylaxis alters outcomes in prospective trials.
Outpatient surgeries account for 60–70% of all procedures. Increased surgical duration has been demonstrated to be an independent risk factor for the development of venous thromboembolism (VTEs) after inpatient surgeries. In contrast, it is currently unknown if surgical duration increases the risk of VTEs for outpatient surgeries. The 2005 through 2016 NSQIP Participant Use Data Files were queried to extract all patients scheduled for outpatient surgery. A z-score for surgical duration was calculated for each procedure to allow for standardization across surgeries of expected shorter or longer duration. The primary outcome measured was incidence of VTEs within 30 days of surgery. A total of 3474 patients out of 1,863,523 (0.19%) had a VTE. After adjusting for confounding factors, the first and fifth quintiles compared to the middle quintile had odds ratios (ORs) of 0.75 (95% CI 0.68, 0.80) and 1.43 (95% CI, 1.35%–1.52%), respectively, P < 0.001. Patients who developed VTEs were more likely to be readmitted to the hospital, OR (95%CI) of 51.9 (48.0–56.2), C statistic = 0.67. Surgical duration is associated with the development of VTEs after outpatient surgery. While the overall incidence of VTE is low and does not require generalized prophylaxis, clinical practitioners should consider prophylaxis for patients undergoing outpatient surgery performed with excessive time compared to the average surgical procedure duration. • Surgical duration is related with VTE development 30 days within outpatient surgery. • Long outpatient surgeries resulted in a 1.43-fold increase in developing a VTE. • Short outpatient surgeries resulted in a 25% reduction in developing a VTE. • ENT surgery had the lowest VTE incidence while vascular surgery had the highest. • Patients who developed VTEs were 52 times more likely to be readmitted.
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Pence et al. (2020) conducted a cohort in Outpatient surgery (n=1,863,523). Longest surgical duration (5th quintile) vs. Average surgical duration (3rd quintile) was evaluated on Incidence of venous thromboembolism within 30 days of surgery (OR 1.43, 95% CI 1.35-1.52, p=<0.001). Outpatient surgeries in the longest duration quintile were associated with a 1.43-fold increased odds of developing venous thromboembolism within 30 days compared to procedures of average duration.
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