1. Identification of patients at high risk for post-discharge venous thromboembolism after hepato-pancreato-biliary surgery: which patients benefit from extended thromboprophylaxis?
- Author
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Beal EW, Tumin D, Chakedis J, Porter E, Moris D, Zhang XF, Abdel-Misih S, Dillhoff M, Manilchuk A, Cloyd J, Schmidt CR, and Pawlik TM
- Subjects
- Aged, Clinical Decision-Making, Databases, Factual, Drug Administration Schedule, Female, Fibrinolytic Agents adverse effects, Humans, Incidence, Male, Middle Aged, North America epidemiology, Patient Selection, Predictive Value of Tests, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Venous Thromboembolism diagnostic imaging, Venous Thromboembolism epidemiology, Biliary Tract Surgical Procedures adverse effects, Decision Support Techniques, Fibrinolytic Agents administration & dosage, Hepatectomy adverse effects, Pancreatectomy adverse effects, Patient Discharge, Venous Thromboembolism prevention & control
- Abstract
Background: 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., Methods: 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)., Results: 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%., Conclusions: Utilizing independent factors associated with post-discharge VTE, a prediction model was able to stratify patients according to risk of VTE and may help identify patients who are most likely to benefit from pharmacoprophylaxis., (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2018
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