Habib Khoury, Robert Lyons, Yas Sanaiha, Sarah Rudasill, Richard J. Shemin, Peyman Benharash
Deep Venous Thrombosis and Pulmonary Embolism in Cardiac Surgical Patients
Background: Deep venous thrombosis and pulmonary embolism are life-threatening complications following surgery, warranting prophylaxis. However, clinical guidelines for thromboembolism prevention in cardiac surgery are lacking. This study aimed to characterize the national incidence, mortality, and costs associated with thromboembolism following cardiac surgery.
Methods: The 2005-2015 National Inpatient Sample was used to identify all adult patients undergoing coronary artery bypass grafting or valve surgery. International Classification of Disease codes were used to identify patients with deep venous thrombosis and pulmonary embolism.
Results: Of approximately 3 million patients undergoing cardiac surgery, 1.62% developed deep venous thrombosis and 0.38% pulmonary embolism. Those with deep venous thrombosis and pulmonary embolism were more commonly female (33.2% and 36.2 vs. 31.2%, P<0.001), older (68.1 and 66.0% vs. 65.7 years, P<0.001), and had a higher Elixhauser comorbidity index (4.0 and 4.7 vs. 3.7, P<0.001). Cardiac surgery patients with deep venous thrombosis and pulmonary embolism had higher rates of mortality (4.95% and 14.8% vs. 2.67%, P<0.001). After adjustment for baseline differences, deep venous thrombosis was associated with an incremental increase in cost of $12,308, while pulmonary embolism was associated with $13,879 cost increase following cardiac surgery. Pulmonary embolism was an independent predictor of mortality (Odds Ratio, 3.39; 95% Confidence Interval 2.74–4.18).
Conclusions: The mortality and financial burden related to thromboembolism in cardiac surgery are significant. Prophylaxis may be indicated in cardiac surgery patients to improve quality of care and reduce healthcare costs. Future controlled randomized trials investigating the benefit of thromboembolism prophylaxis in cardiac surgery are warranted.