Early outcomes and risk factors in venous thrombectomy: an analysis of the American College of Surgeons NSQIP dataset

Abstract

Objectives: Thrombus removal has been shown to improve venous physiology in acute iliofemoral deep-venous thrombosis. Our study focuses on the contemporary application of venous thrombectomy based on data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).

Methods: Data submitted by over 200 hospitals to the ACS NSQIP participant use file was accessed for the years 2005-2008. The ACS NSQIP protocol provides clinically rigorous preoperative risk and 30-day outcomes for a prospective and systematic sample of vascular surgery patients. Patients were identified who had undergone venous thrombectomy through leg access (Primary procedure CPT 34421 or 34451). Demographic and clinical variables along with 30-day morbidity (1 or more of 21 defined complications) and mortality were evaluated. Secondary/concomitant procedures CPT codes were collected. Univariate analysis between groups was performed using χ( 2) or T-tests with P ≤ .05 considered significant.

Results: A total of 91 patients were identified who underwent primary venous thrombectomy. The mean age was 62.5 ± 15.8 y and 45 of 91 (49.5%) were female. Thirty-day mortality was 8.8% (8/91). Composite morbidity was 25.3% (23/91). Intraoperative transfusion was required in 18.7% of the patients, lower extremity fasciotomy was performed in 8.8% of the patients and an inferior vena cava (IVC) filter was placed in 2.2% of the patients. An arteriovenous anastomosis was created in only 1 patient; venous angioplasty was performed in 3.3% of the patients.

Conclusions: Venous thrombectomy is associated with significant postoperative morbidity and mortality. This is at least partially due to the associated comorbidities of this patient population, approximately 1/5 in our study were ASA class 4. Most frequent causes of morbidity are pulmonary and wound infection complications. Only 2 patients had an IVC filter placed during the operation. Adjunctive procedures to assist vein patency such as arteriovenous fistula creation or venous angioplasty were infrequently performed.