Identification of patients at high risk for post-discharge venous thromboembolism after hepato-pancreato-biliary surgery: which patients benefit from extended thromboprophylaxis?

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Eliza W BealTimothy M Pawlik

Abstract

The objective of the current study was to define risk factors associated with the 30-day post-operative risk of VTE after HPB surgery and create a model to identify patients at highest risk of post-discharge VTE. Patients who underwent hepatectomy or pancreatectomy in the ACS-NSQIP Participant Use Files 2011-2015 were identified. Logistic regression modeling was used; a model to predict post-discharge VTE was developed. Model discrimination was tested using area under the curve (AUC). Among 48,860 patients, the overall 30-day incidence of VTE after hepatectomy and pancreatectomy was 3.2% (n = 1580) with 1.1% (n = 543) of VTE events occurring after discharge. Patients who developed post-discharge VTE were more likely to be white, had a higher median BMI, have undergone pancreatic surgery, had longer median operative times, and to have had a transfusion. A weighted prediction model demonstrated good calibration and fair discrimination (AUC = 0.63). A score of ≥-4.50 had maximum sensitivity and specificity, resulting in 44% of patients being treating with prophylaxis for an overall VTE risk of 1.1%. Utilizing independent factors associated with post-discharge VTE, a prediction model was able to stratify patients according to risk ...Continue Reading

Citations

Jan 24, 2019·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Nicholas J SkertichXavier M Keutgen
Sep 30, 2020·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Cary Jo R SchlickDavid J Bentrem
Aug 28, 2021·World Journal of Clinical Cases·Takahisa Fujikawa, Shigetoshi Naito

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