Extended-duration thromboprophylaxis after ventral hernia repair: a risk model to predict venous thrombotic events after hospital discharge

Abstract

Background Venous thromboembolism (VTE) is a major source of morbidity and mortality after ventral hernia surgery, but the risk of VTE after discharge has not been reported. Study design Data from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) were used to investigate the risk of post-discharge VTE. Current procedural terminology (CPT) codes identified all reported patients who underwent ventral hernia repair from 2011 to 2017. We created a multivariable regression model for post-discharge VTE, using the 2011–2016 dataset to develop the model and 2017 as a validation set. The prediction model was used to create a risk calculator as a mobile application. Results The rate of VTE after surgery was 0.62% (878 of 141,065) with 48% occurring after discharge from the hospital. The final predictor model consisted of eight variables: age > 60 years, male sex, body mass index (BMI) ≥ 35 kg/m2), operative time > 2 h, concurrent panniculectomy, post-operative hospitalization > 1 day, presence of bleeding disorder, and emergency operation. The model had good calibration and discrimination (Hosmer–Lemeshow goodness-of-fit test, p = 0.71; c-statistic = 0.71). Threshold analysis showed a strategy of extended-duration thromboprophylaxis was optimized when the risk of post-discharge VTE was > 0.3%. Conclusion Forty-eight percent of VTEs after ventral hernia repair occur after discharge, particularly in older, male, obese patients undergoing longer and complex operations that require hospitalization > 1 day. Post-discharge thromboprophylaxis should be considered in these patients, particularly when risk of VTE exceeds 0.3%.

Approaches for optimizing venous thromboembolism prevention in injured patients: Findings from the consensus conference to implement optimal venous thromboembolism prophylaxis in trauma

“…Additional risk factors at 1 year were discharge to extended care facilities, age older than 64 years, index admission operation, and hospital length of stay >7 days 45 . Extended VTE risk has also been documented in a variety of general surgical and surgical oncological conditions, including patients undergoing surgery for inflammatory bowel disease, 62,63 ventral hernia, 64 and abdominal/pelvic cancer, 65 and in mixed surgical populations 52 …”

“…Additional risk factors at 1 year were discharge to extended care facilities, age older than 64 years, index admission operation, and hospital length of stay >7 days. 45 Extended VTE risk has also been documented in a variety of general surgical and surgical oncological conditions, including patients undergoing surgery for inflammatory bowel disease, 62,63 ventral hernia, 64 and abdominal/pelvic cancer, 65 and in mixed surgical populations. 52 Assessed two difference doses of dabigatran daily vs. enoxaparin daily for THA; no difference in overall VTE or death between the three groups and no difference in major bleeding Eriksson et al, 55 2008 Prospective, randomized control Daily rivaroxaban was found to reduce total VTE more effectively than daily LMWH after total hip replacement (0.2% vs. 2%, p < 0.001) Lassen et al, 56 2008 Prospective, randomized control Daily rivaroxaban was found to reduce total VTE more effectively than daily LMWH after total knee replacement (1% vs. 2.6%, p = 0.005) Raskob et al, 57 2012 Pooled data meta-analysis Twice-daily extended duration apixaban demonstrated reduced VTE incidence following total knee or hip replacement compared with daily LMWH (0.7% vs. 1.5%, p = 0.001) Anderson et al, 58 2013 Prospective, randomized control Following total hip replacement, patients were given LMWH or aspirin for 28 d following discharge without a significant difference in rates of either VTE or major bleeding Haac et al, 33 2020 Prospective, randomized control Patients with pelvic or extremity fractures were given either LWMH twice daily or aspirin twice daily upon discharge.…”