Preoperative sepsis and postoperative thrombosis

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5444 (Published 08 September 2014) Cite this as: BMJ 2014;349:g5444
  1. Paul S Myles, professor/director
  1. 1Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Vic 3004, Australia
  1. p.myles{at}alfred.org.au

Clearly associated in observational research, but changes to surgical care would be premature

Large scale cohort or registry data can provide relevant information about “real world” clinical practice.1 2 Such efforts provide valuable information to help evaluate processes and outcomes of care, including benchmarking and other quality improvement initiatives.3 They can also identify patient and clinical characteristics, practice patterns, and variations in care that are associated with poor outcomes. Large observational studies, including registries, help us recognise those factors that can be modified in the hope that patient outcome can be improved. But, as is so often stated, we must be cautious when trying to make causal inferences from associations identified in observational studies.

In a linked study, Donzé and colleagues (doi:10.1136/bmj.g5334) report findings from their analysis of data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.4 Their data came from 374 hospitals and more than 2.3 million adults who underwent a broad range of surgical procedures. They found that patients with signs of systemic inflammation or sepsis in the preoperative period had a roughly threefold increased risk of postoperative arterial or venous thrombosis up to 30 days after surgery. Arterial events included …

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