Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy

Schlick, Cary Jo R.; Ellis, Ryan J.; Merkow, Ryan P.; Yang, Anthony D.; Bentrem, David J.

doi:10.1016/j.hpb.2020.09.008

Cited by 7 publications

(6 citation statements)

References 53 publications

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“…This study suggests that risk-based deescalation may be warranted for certain urological operations, specifically those involving the prostate or kidney that have short lengths of hospital stay and high utilization of minimally invasive surgery. This study also supports further development of VTE risk calculators that are both population-specific and procedure site–specific to guide chemoprophylaxis use …”

Section: Discussionsupporting

confidence: 74%

“…Despite variation by specialty with regard to inpatient VTE chemoprophylaxis ordering, rates of VTE in the VHA were similar to those in other non-VHA health systems. 17 , 22 , 24 , 25 , 26 Inpatient VTE chemoprophylaxis administration is a multilevel process with many areas for potential failure, but we found that rates of ordering (80.4%) were concordant with rates of documented administration (99.5%), which indicates a comparably high level of performance at VHA hospitals. 14 …”

Section: Discussionmentioning

confidence: 69%

“…However, given that our data show that variation in postdischarge VTE chemoprophylaxis prescribing was particularly notable, improvement initiatives appropriately targeted by specialty and procedure may be warranted. There may also be a need for individualized risk-based prescribing of postdischarge prophylaxis given the variation associated with procedure site …”

Section: Discussionmentioning

confidence: 99%

“…There may also be a need for individualized risk-based prescribing of postdischarge prophylaxis given the variation associated with procedure site. 24 , 25 , 27 …”

Section: Discussionmentioning

confidence: 99%

“…There may also be a need for individualized risk-based prescribing of postdischarge prophylaxis given the variation associated with procedure site. 24,25,27 Some specialty variation for chemoprophylaxis may be justified given the low risks of overall VTE and postdischarge VTE. We found that patients who underwent urological procedures of the kidney and prostate were significantly less likely to receive inpatient VTE chemoprophylaxis…”

Section: Urologicmentioning

confidence: 99%

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Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery

Logan,

Hudnall,

Schlick

et al. 2023

JAMA Netw Open

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ImportanceVenous thromboembolism (VTE) represents a major source of preventable morbidity and mortality and is a leading cause of death in the US after cancer surgery. Previous research demonstrated variability in VTE chemoprophylaxis prescribing, although it is unknown how these rates compare with performance in the Veterans Health Administration (VHA).ObjectiveTo determine VTE rates after cancer surgery, as well as rates of inpatient and outpatient (posthospital discharge) chemoprophylaxis adherence within the VHA.Design, Setting, and ParticipantsThis retrospective cohort study within 101 hospitals of the VHA health system included patients aged 41 years or older without preexisting bleeding disorders or anticoagulation usage who underwent surgical treatment for cancer with general surgery, thoracic surgery, or urology between January 1, 2015, and December 31, 2022. The VHA Corporate Data Warehouse, Pharmacy Benefits Management database, and the Veterans Affairs Surgical Quality Improvement Program database were used to identify eligible patients. Data analysis was conducted between January 2022 and July 2023.ExposuresInpatient surgery for cancer with general surgery, thoracic surgery, or urology.Main Outcomes and MeasuresRates of postoperative VTE events within 30 days of surgery and VTE chemoprophylaxis adherence were determined. Multivariable Poisson regression was used to determine incidence-rate ratios of inpatient and postdischarge chemoprophylaxis adherence by surgical specialty.ResultsOverall, 30 039 veterans (median [IQR] age, 67 [62-71] years; 29 386 men [97.8%]; 7771 African American or Black patients [25.9%]) who underwent surgery for cancer and were at highest risk for VTE were included. The overall postoperative VTE rate was 1.3% (385 patients) with 199 patients (0.7%) receiving a diagnosis during inpatient hospitalization and 186 patients (0.6%) receiving a diagnosis postdischarge. Inpatient chemoprophylaxis was ordered for 24 139 patients (80.4%). Inpatient chemoprophylaxis ordering rates were highest for patients who underwent procedures with general surgery (10 102 of 10 301 patients [98.1%]) and lowest for patients who underwent procedures with urology (11 471 of 17 089 patients [67.1%]). Overall, 3142 patients (10.5%) received postdischarge chemoprophylaxis, with notable variation by specialty.Conclusions and RelevanceThese findings indicate the overall VTE rate after cancer surgery within the VHA is low, VHA inpatient chemoprophylaxis rates are high, and postdischarge VTE chemoprophylaxis prescribing is similar to that of non-VHA health systems. Specialty and procedure variation exists for chemoprophylaxis and may be justified given the low risks of overall and postdischarge VTE.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

“…There may also be a need for individualized risk-based prescribing of postdischarge prophylaxis given the variation associated with procedure site. 24 , 25 , 27 …”

Section: Discussionmentioning

confidence: 99%

Section: Urologicmentioning

confidence: 99%

See 3 more Smart Citations

Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery

Logan,

Hudnall,

Schlick

et al. 2023

JAMA Netw Open

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Post-hepatectomy venous thromboembolism: a systematic review with meta-analysis exploring the role of pharmacological thromboprophylaxis

Karunakaran

Kaur²,

Ismail

et al. 2022

Langenbecks Arch Surg

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Purpose Patients undergoing hepatectomy are at moderate-to-high risk of venous thromboembolism (VTE). This study critically examines the efficacy of combining pharmacological (PTP) and mechanical thromboprophylaxis (MTP) versus only MTP in reducing VTE events against the risk of hemorrhagic complications. Methods A systematic review of major reference databases was undertaken, and a meta-analysis was performed using common-effects model. Risk of bias assessment was performed using Newcastle–Ottawa scale. Trial sequential analysis (TSA) was used to assess the precision and conclusiveness of the results. Results 8 studies (n = 4238 patients) meeting inclusion criteria were included in the analysis. Use of PTP + MTP was found to be associated with significantly lower VTE rates compared to only MTP (2.5% vs 5.3%; pooled RR 0.50, p = 0.03, I2 = 46%) with minimal type I error. PTP + MTP was not associated with an increased risk of hemorrhagic complications (3.04% vs 1.9%; pooled RR 1.54, p = 0.11, I2 = 0%) and had no significant impact on post-operative length of stay (12.1 vs 10.8 days; pooled MD − 0.66, p = 0.98, I2 = 0%) and mortality (2.9% vs 3.7%; pooled RR 0.73, p = 0.33, I2 = 0%). Conclusion Despite differences in the baseline patient characteristics, extent of hepatectomy, PTP regimens, and heterogeneity in the pooled analysis, the current study supports the use of PTP in post-hepatectomy patients (grade of recommendation: strong) as the combination of PTP + MTP is associated with a significantly lower incidence of VTE (level of evidence, moderate), without an increased risk of post-hepatectomy hemorrhage (level of evidence, low).

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Association of pathologic factors with postoperative venous thromboembolism after gastrointestinal cancer surgery

Janczewski,

Silver,

Schlick

et al. 2024

Journal of Gastrointestinal Surgery

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Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy

Cited by 7 publications

References 53 publications

Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery

Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery

Post-hepatectomy venous thromboembolism: a systematic review with meta-analysis exploring the role of pharmacological thromboprophylaxis

Association of pathologic factors with postoperative venous thromboembolism after gastrointestinal cancer surgery

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