Surgical-site infections may increase risk of deadly blood clots after colorectal surgery

January 16, 2013, Johns Hopkins University School of Medicine

Despite receiving blood thinners and other clot prevention treatment, some patients still develop potentially lethal blood clots in the first month after their operations anyway, especially if they developed a surgical-site infection while in the hospital, according to results of a study at Johns Hopkins.

The research, described in a report published in the , found that who experience a surgical-site infection after their are four times more likely than infection-free patients to develop a deep-vein thrombosis (DVT) in the legs, or its more deadly cousin, a (PE) in the lungs. While only 4 percent of patients developed a DVT, 92 percent of those who did had received prophylaxis that previous research has shown is the best practice for prevention.

"We need heightened awareness about the potential for venous thromboembolism (VTE) in patients with surgical-site infections," says study leader Susan L. Gearhart, M.D., an associate professor of surgery at the Johns Hopkins University School of Medicine. "We need to think beyond the prophylaxis we are already giving these patients. We need to think smarter."

Nearly all surgical patients at The Johns Hopkins Hospital are routinely given proven treatments to prevent VTEs, usually the regular administration of low-dose and the use of compression devices to keep blood flowing in the legs. Typically the treatments cease when people are discharged from the hospital.

Gearhart notes that much work in hospitals has gone into ensuring compliance with prophylaxis measures, including automated checklists to remind of their importance. VTEs are considered a form of preventable harm, and the Centers for Medicare & Medicaid Services may penalize hospitals where patients develop clots after some orthopedic procedures. But this new study shows that even when hospitals comply with prevention guidelines, VTEs can still occur.

For their study, Gearhart and her colleagues reviewed the records of 615 adults who underwent colorectal surgery at The Johns Hopkins Hospital between July 2009 and July 2011. Twenty-five (4.1 percent) developed VTE. Among patients who experienced a VTE, 92 percent had been given risk-appropriate VTE prophylaxis.

What was even more interesting to Gearhart, she says, was that 14 of the 25 patients with VTE (56 percent) also developed postoperative infections compared with 168 patients (28.5 percent) without VTE. The infectious complications in nine of the 14 patients (64.3 percent) occurred prior to or on the same day as the VTE. She says she had never before seen a link between infections and VTE in .

One theory for the apparent link is that an increase of inflammatory protein molecules that accompanies an infection affects the functioning of platelets in the blood, which could increase the risk of thrombosis. Platelets are the sticky cells that facilitate clot formation in the blood.

Gearhart says it may be time to conduct more intense monitoring of colorectal surgery patients who develop surgical-site infections, and consider frequent screening for clots in those with infections. Such screening can be done with ultrasound equipment. She also suggests such patients be kept on blood thinners for 30 days after regardless of when they are discharged.

Explore further: Preventing deadly blood clots: Study finds computerized checklist better at finding best preventive strategy

Related Stories

Preventing deadly blood clots: Study finds computerized checklist better at finding best preventive strategy

October 15, 2012
A computerized checklist system designed to help physicians identify and use the best methods of preventing potentially deadly blood clots in hospitalized trauma patients dramatically reduced the number of these dangerous ...

ACP recommends new approach to prevent venous thromboembolism in hospitalized patients

October 31, 2011
In a new clinical practice guideline published today in Annals of Internal Medicine, the American College of Physicians (ACP) recommends that doctors assess the risk of thromboembolism and bleeding in patients hospitalized ...

Outpatient surgery patients also at risk for blood clots

April 24, 2012
A University of Michigan Health System study examined who's having outpatient surgery in the U.S. today, and showed 1 in 84 highest-risk patients suffers a dangerous blood clot after surgery.

Blood thinner may protect cancer patients from potentially fatal clots

June 7, 2011
A new type of anti-clotting drug called semuloparin has been found to reduce the development of potentially fatal blood clots in the veins that often occur in cancer patients, doctors at Duke Cancer Institute and elsewhere ...

Patients with inflammatory bowel disease appear to be at increased risk for post-operative DVT, PE

October 17, 2011
Patients with inflammatory bowel disease (IBD) undergoing surgery may be more likely to develop deep vein thrombosis (DVT; blood clot in a deep vein in the thigh or leg) or pulmonary embolism (PE; blood clot in blood vessels ...

In colorectal surgery, risk for blood clots appears higher with open method versus laparoscopy

June 20, 2011
The risk of developing venous thromboembolism (VTE) may be nearly twice as high for patients undergoing open surgery for colorectal problems, versus those undergoing laparoscopic colorectal (LC) resections, according to a ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.