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

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 Journal of the American College of Surgeons, found that patients who experience a surgical-site infection after their abdominal surgery 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 pulmonary embolism (PE) in the lungs.

While only 4 per cent of patients developed a DVT, 92 per cent 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, MD, 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 blood thinners 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 health care workers of their importance. VTEs are considered a form of preventable harm, and the Centers for Medicare & Medicaid Services may penalise 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.