A significant proportion of venous thromboembolism events in general surgical patients occurs after discharge: analysis of the ACS-NSQIP Essentials database

Salous, Abdelghaffar K.; Reyad, Ashraf; Sweeney, karen; Mavanur, Arun

doi:10.1186/s13741-019-0131-1

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Venous thromboembolism (VTE) is a complex multifactorial clinical entity associated with significant morbidity and mortality and can present either as deep venous thrombosis (DVT) and/or concomitant pulmonary embolism (PE) [ 32 ]. VTE in malignancies is multifactorial—it can be cancer-related, as well as individual-related.…”

Section: Discussionmentioning

confidence: 99%

“…VTE does have a considerable impact on morbidity, mortality, and economic cost, and has led to the development of VTE risk stratification tools such as the Caprini risk assessment [ 32 ]. In addition to VTE risks associated with major surgical procedures and underlying malignancy, the American Heart Association (AHA) has identified additional factors including prior VTE, age, obesity, immobility, and family history.…”

Section: Discussionmentioning

confidence: 99%

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Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis

Wani

Al-Mitwalli

Mukherjee

et al. 2023

JCM

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Radical prostatectomy (RP) is one of the recommended treatments to achieve oncological outcomes in localized prostate cancer. However, a radical prostatectomy is a major abdominopelvic surgery. Venous thromboembolism (VTE) is a well-known complication associated with surgical procedures, including RP. There is a lack of consensus regarding VTE prophylaxis in urological procedures. The aim of this systematic review and meta-analysis was to investigate different aspects of VTE in post-radical prostatectomy patients. A comprehensive literature search was performed, and relevant data were extracted. The primary aim was to perform a systematic review and meta-analysis (wherever possible) of VTE occurrence in post-RP patients in relation to surgical approach, pelvic lymph node dissection, and type of prophylaxis (mechanical or combined prophylaxis). The secondary aim was to investigate the incidence and other risk factors of VTE in post-RP patients. A total of 16 studies were included for quantitative analysis. Statistical methods for analysis included the DerSimonian–Laird random effects. We were able to conclude that the overall incidence of VTE in post-radical prostatectomy is 1% (95% CI) and minimally invasive procedures (MIS), including laparoscopic, as well as robotic procedures for radical prostatectomy and RP without pelvic lymph node dissection (PLND), are associated with less risk of developing VTE. Additional pharmacological prophylaxis to mechanical methods may not be necessary in all cases and should be considered in high-risk patients only.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis

Wani

Al-Mitwalli

Mukherjee

et al. 2023

JCM

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“…13 ACCP 2012 guidelines also recommended pharmacologic prophylaxis for 4 weeks with LMWH for patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer who are not otherwise at high risk for major bleeding (Grade 1B) 6,13 Our study showed that 49.9% of VTE complications occurred after discharge from initial hospitalization, consistent with other studies. 14,15 Extended thromboprophylaxis could be more broadly applied with a better determination of an individual’s risk, which our model provides. A prospective, observational study in 2373 patients undergoing cancer surgery demonstrated that VTE was the most common cause of mortality, responsible for 46.3% of postoperative deaths.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Postoperative Venous Thromboembolism risk prediction model

Woo

Rhoades

Ackermann

et al. 2020

Preprint

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Background: VTE is a serious postoperative complication after surgery with resultant higher morbidity and mortality. Despite years of experience with current risk models, rates continue to be high and more information is needed on individual patient risk in the prophylaxis era. Research Questions: Can we assess the individualized risk of postoperative venous thromboembolism (VTE) for broad categories of surgery? Methods: This study was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database. Patient data (n=2,875,190) from 2015-2017 were used for study analysis. Eight predictors were selected for the model: age, preoperative platelet count≥450 (x109/L), disseminated cancer, corticosteroid use, serum albumin ≤2.5 g/dL, preoperative sepsis, hospital length of stay and surgery type. The second model included 7 predictors without hospital length of stay. A predictive model was trained using ACS-NSQIP data from 2015-2016 (n=1,859,227) and tested using data from 2017 (n= 1,015,963). Primary outcomes are postoperative 30-day VTE, including deep vein thrombosis (DVT) and/or pulmonary embolism (PE). Results: VTE occurred in 23,249 patients (0.81%) and 49.9% of VTE occurred after discharge from index hospitalization. The risk prediction model had high AUC (area under the receiver operating characteristic curve) for postoperative VTE of 0.78 (training cohort) and 0.78 (test cohort). Interpretation: This clinical prediction model is a validated, practical and easy-to-use tool to identify surgical patients at the highest risk of postoperative VTE and provide an individualized assessment of risk based on clinical factors and type of surgery. This prediction model may be used as a tool to assess individualized risk of postoperative VTE and promote broader discussion and awareness of the VTE risk during the perioperative period.

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“…Venous thromboembolism (VTE) representing the third most common cause of hospital-related deaths in the United States [1][2][3][4][5][6] and vary across surgical specialties. [7][8][9][10][11][12][13][14][15][16][17] In otolaryngology (ORL) patients, postoperative VTE rates from 0% to 2%, [18][19][20][21][22][23][24][25] with more recent studies reporting rates of 0.02% to 1.3% that varies with the type of ORL procedure performed. [25][26][27] VTE in ORL patients most commonly occur after hospital discharge, [28][29][30][31] with reported post-discharge VTE rates from 0.2% to 7.4%.…”

Section: Introductionmentioning

confidence: 99%

“…Venous thromboembolism (VTE) representing the third most common cause of hospital‐related deaths in the United States 1–6 and vary across surgical specialties 7–17 . In otolaryngology (ORL) patients, postoperative VTE rates from 0% to 2%, 18–25 with more recent studies reporting rates of 0.02% to 1.3% that varies with the type of ORL procedure performed 25–27 .…”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis in Otolaryngologic Patients Using Caprini Assessment

Edwards,

Brennan,

Rutt

et al. 2023

The Laryngoscope

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ObjectiveThe aim was to determine the utilization of Caprini guideline‐indicated venous thromboembolism (VTE) prophylaxis and impact on VTE and bleeding outcomes in otolaryngology (ORL) surgery patients.MethodsElective ORL surgeries performed between 2016 and 2021 were retrospectively identified. Logistic regression models were used to examine the association between patient characteristics and receiving appropriate prophylaxis, inpatient, 30‐ and 90‐day VTE and bleeding events.ResultsA total of 4955 elective ORL surgeries were analyzed. Thirty percent of the inpatient cohort and 2% of the discharged cohort received appropriate risk‐stratified VTE prophylaxis. In those who did not receive appropriate prophylaxis, overall inpatient VTE was 3.5‐fold higher (0.73% vs. 0.20%, p = 0.015), and all PE occurred in this cohort (0.47% vs. 0.00%, p = 0.005). All 30‐ and 90‐day discharged VTE events occurred in those not receiving appropriate prophylaxis. Inpatient, 30‐ and 90‐day discharged bleeding rates were 2.10%, 0.13%, and 0.33%, respectively. Although inpatient bleeding was significantly higher in those receiving appropriate prophylaxis, all 30‐ and 90‐day post‐discharge bleeding events occurred in patients not receiving appropriate prophylaxis. On regression analysis, Caprini score was significantly positively associated with likelihood of receiving appropriate inpatient prophylaxis (odds ratio [OR] 1.05, confidence interval [CI] 1.03–1.07) but was negatively associated in the discharge cohort (OR 0.43, CI 0.36–0.51). Receipt of appropriate prophylaxis was associated with reduced odds of inpatient VTE (OR 0.24, CI 0.06–0.69), but not with risk of bleeding.ConclusionAlthough Caprini VTE risk‐stratified prophylaxis has a positive impact in reducing inpatient and post‐discharge VTE, it must be balanced against the risk of inpatient postoperative bleeding.Level of Evidence3 Laryngoscope, 2023

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A significant proportion of venous thromboembolism events in general surgical patients occurs after discharge: analysis of the ACS-NSQIP Essentials database

Cited by 6 publications

References 11 publications

Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis

Venous Thromboembolism (VTE) in Post-Prostatectomy Patients: Systematic Review and Meta-Analysis

Development and Validation of Postoperative Venous Thromboembolism risk prediction model

Venous Thromboembolism Prophylaxis in Otolaryngologic Patients Using Caprini Assessment

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