Long-haul air travel before major surgery: A prescription for thromboembolism?

OBJECTIVE: To investigate the incidence of postoperative venous thromboembollsm (VTE) in patients who had flown long distances before major surgery. PATIENTS AND METHODS: Using the Mayo Clinic computerized patient database, we identified patients who had flown more than 5000 km before major surgery (travelers) and had experienced an episode of clinically significant VTE within 28 days after surgery. Individual medical records were reviewed for the diagnosis of VTE, pertinent risk factors, and outcome. We compared the incidence of VTE in travelers to the incidence of VTE in patients from North America (nontravelers) undergoing similar surgical procedures. RESULTS: Eleven patients met our criteria for long-haul air travel and clinically significant VTE within 28 days after surgery. Compared with nontravelers undergoing similar surgical procedures, long-haul travelers had a higher incidence of VTE (4.9% vs 0.15%; P<.001). Compared with nontravelers who developed VTE, travelers were younger (P=.006), developed VTE earlier in the postoperative course (P=.01). had higher American Society of Anesthesiologists physical status classification (P=.02), and had higher prevalence of smoking (P=.007). Of the 11 travelers with VTE, 10 were of Middle Eastern origin. CONCLUSION: Prolonged air travel before major surgery significantly increases the risk of perioperative VTE. Such patients should receive more intensive VTE prophylactic measures during the flight and throughout the perioperative period.