Hospital Length of Stay Is Associated With Increased Likelihood for Venous Thromboembolism After Total Joint Arthroplasty

Salomon, Brett; Dasa, Vinod; Krause, Peter C.; Hall, Lauren; Chapple, Andrew G.

doi:10.1016/j.artd.2020.12.025

Cited by 23 publications

(12 citation statements)

References 18 publications

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“…Patients with longer lengths of stay may have increased our cohort's risk for VTE, a finding supported by Salomon et al, which found that the risk for VTE increased for patients who had longer lengths of stay after orthopedic surgery. 27 Additionally, patients in our study may have benefited from extended anticoagulation upon discharge. Current guidelines by the ACCP state that for patients at high risk for VTE following hip and knee replacement, prophylaxis should be extended by an additional three weeks.…”

Section: Discussionmentioning

confidence: 88%

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Raymer

Schafer

et al. 2023

J Reconstr Microsurg

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Background Deep inferior epigastric perforator (DIEP) flaps are commonly used for autologous breast reconstruction, but reported rates of venous thromboembolism (VTE) are up to 6.8%. This study aimed to determine incidence of VTE based on preoperative Caprini score following DIEP breast reconstruction. Methods This retrospective study included patients who underwent DIEP flaps for breast reconstruction between January 1, 2016 and December 31, 2020 at a tertiary-level, academic institution. Demographics, operative characteristics, and VTE events were recorded. Receiver operating characteristic (ROC) analysis was performed to determine area under curve (AUC) of Caprini score for VTE. Univariate and multivariate analyses assessed risk factors associated with VTE. Results This study included 524 patients (mean age 51.2±9.6 years). There were 123 (23.5%) patients with Caprini score of 0-4, 366 (69.8%) with scores 5-6, 27 (5.2%) with scores 7-8, and 8 (1.5%) patients with scores >8. Postoperative VTE occurred in 11 (2.1%) patients, at a median time of 9 days (range 1-30) after surgery. VTE incidence by Caprini score was 1.9% for scores 3-4, 0.8% for scores 5-6, 3.3% for scores 7-8, and 13% for scores >8. Caprini score achieved an AUC of 0.70. A Caprini score >8 was significantly predictive of VTE on multivariable analysis relative to scores 5-6 (OR 43.41, 95% CI 7.46-252.76, p<0.001). Conclusions In patients undergoing DIEP breast reconstruction, VTE incidence was highest (13%) in Caprini scores greater than 8 despite chemoprophylaxis. Future studies are needed to assess the role of extended chemoprophylaxis in patients with high Caprini scores.

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Section: Discussionmentioning

confidence: 88%

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Raymer

Schafer

et al. 2023

J Reconstr Microsurg

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“…The association of VTE with in-hospital mortality is likely due to immortal time bias, with a rate of thrombosis per day of 0.01 +/-0.02 for those who survived vs 0.003+/-0.02 for those who died. VTE is highly dependent on length of hospital stay as has been shown in numerous cohorts including our data where the risk of VTE increased by 5% per each additional day of hospitalization (29,30). A landmark analysis was performed to overcome this important survival bias.…”

Section: Discussionmentioning

confidence: 99%

Bleeding And Thrombosis In Patients With Out Of Hospital VT/VF Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Gutierrez,

Kalra,

Chang

et al. 2023

Preprint

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BackgroundExtracorporeal cardiopulmonary resuscitation (eCPR) improves outcomes after out of hospital cardiac arrest (OHCA). However, bleeding and thrombosis are common complications. The post cardiac arrest syndrome including trauma and altered hemostasis creates challenges when balancing the risk of bleeding versus thrombosis. We aimed to describe the incidence and predictors of bleeding and thrombosis and their association with in-hospital mortality.MethodsConsecutive patients presenting with refractory VT/VF OHCA between December 2015 and March 2022 who met criteria for eCPR initiation at our center were included. Patients were anticoagulated with unfractionated heparin while on ECMO. Major bleeding was defined by the extracorporeal life support organization’s (ELSO) criteria as clinically significant bleed associated with transfusion of ≥2 units of red blood cells in 24h or bleeding in a critical area. Thrombosis was defined by clinical signs and symptoms and or imaging evidence of thrombi. Adjusted analyses were done to seek out risk factors for bleeding and thrombosis and evaluate their association with mortality.ResultsMajor bleeding occurred in 135/200 patients (67.5%) with traumatic bleeding from CPR in 73/200 (36.5%). Baseline demographics and arrest characteristics were similar between groups. In multivariable regression analysis only fibrinogen was independently associated with bleeding (aHR 0.98 per every 10mg/dl rise, 95% CI: 0.96-0.99). Patients who died had a higher rate of bleeds per day (0.21 vs 0.03,p<0.001) though bleeding was not significantly associated with in-hospital death (aHR 0.81, 95% CI: 0.55-1.19). A thrombotic event occurred in 23.5% (47/200). Venous thromboembolism (VTE) occurred in 11% (22/200) and arterial thrombi in 15.5% (31/200). Clinical characteristics were comparable between groups. In adjusted analyses, antithrombin III level on admission (aHR 0.97, 95% CI: 0.94-0.99) and use of dual anti-platelet therapy (DAPT) (aHR 0.31, 95% CI: 0.11-0.86) were associated with the incidence of thrombosis. Thrombosis was not associated with in-hospital death (aHR 0.65, 95% CI: 0.42- 1.03).ConclusionBleeding is a frequent complication of eCPR that is associated with decreased fibrinogen levels on admission. Thrombosis is less common occurring in 24% of the cohort. Neither bleeding nor thrombosis was significantly associated with in-hospital mortality.Clinical PerspectiveWhat is new?In this large single center study with a protocolized approach to anticoagulation for patients with VT/VF OHCA bleeding as defined by ELSO major bleeding was common occurring in 68% of the cohort while thrombosis was less frequent occurring in 24% with the more than half of the events being arterial thrombi.Bleeding events are multifactorial including trauma from prolonged CPR, access site bleeding, and mucosal bleeding.Neither bleeding nor thrombosis is associated with overall in-hospital mortality.What are the Clinical implications?The high incidence of bleeding and low incidence of thrombosis with the current approach to anticoagulation which often involves antithrombotic therapy reinforces the need for a better method to risk stratify patients to better tailor anticoagulation strategies.The lack of association of bleeding and thrombotic events with mortality support a less aggressive anticoagulation strategy to minimize bleeding.

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“…Furthermore, a study by Børvik et al [ 58 ] revealed that individuals with severe COPD might face an elevated risk of developing secondary VTE and have higher mortality rates in comparison to their counterparts without VTE post-surgery. Similarly, studies suggest the length of hospital stay as an important risk factor for the onset of VTE events in surgical patients[ 59 ]. Our investigation also indicated a heightened risk of VTE associated with a longer hospital stay among patients who underwent RYGB.…”

Section: Discussionmentioning

confidence: 99%

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

Ali,

Inayat,

Moond

et al. 2024

World J Gastrointest Surg

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BACKGROUND Roux-en-Y gastric bypass (RYGB) is a widely recognized bariatric procedure that is particularly beneficial for patients with class III obesity. It aids in significant weight loss and improves obesity-related medical conditions. Despite its effectiveness, postoperative care still has challenges. Clinical evidence shows that venous thromboembolism (VTE) is a leading cause of 30-d morbidity and mortality after RYGB. Therefore, a clear unmet need exists for a tailored risk assessment tool for VTE in RYGB candidates. AIM To develop and internally validate a scoring system determining the individualized risk of 30-d VTE in patients undergoing RYGB. METHODS Using the 2016–2021 Metabolic and Bariatric Surgery Accreditation Quality Improvement Program, data from 6526 patients (body mass index ≥ 40 kg/m2) who underwent RYGB were analyzed. A backward elimination multivariate analysis identified predictors of VTE characterized by pulmonary embolism and/or deep venous thrombosis within 30 d of RYGB. The resultant risk scores were derived from the coefficients of statistically significant variables. The performance of the model was evaluated using receiver operating curves through 5-fold cross-validation. RESULTS Of the 26 initial variables, six predictors were identified. These included a history of chronic obstructive pulmonary disease with a regression coefficient (Coef) of 2.54 (P < 0.001), length of stay (Coef 0.08, P < 0.001), prior deep venous thrombosis (Coef 1.61, P < 0.001), hemoglobin A1c > 7% (Coef 1.19, P < 0.001), venous stasis history (Coef 1.43, P < 0.001), and preoperative anticoagulation use (Coef 1.24, P < 0.001). These variables were weighted according to their regression coefficients in an algorithm that was generated for the model predicting 30-d VTE risk post-RYGB. The risk model's area under the curve (AUC) was 0.79 [95% confidence interval (CI): 0.63-0.81], showing good discriminatory power, achieving a sensitivity of 0.60 and a specificity of 0.91. Without training, the same model performed satisfactorily in patients with laparoscopic sleeve gastrectomy with an AUC of 0.63 (95%CI: 0.62-0.64) and endoscopic sleeve gastroplasty with an AUC of 0.76 (95%CI: 0.75-0.78). CONCLUSION This simple risk model uses only six variables to assist clinicians in the preoperative risk stratification of RYGB patients, offering insights into factors that heighten the risk of VTE events.

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Hospital Length of Stay Is Associated With Increased Likelihood for Venous Thromboembolism After Total Joint Arthroplasty

Cited by 23 publications

References 18 publications

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Incidence of Venous Thromboembolism Based on Caprini Score in Deep Inferior Epigastric Perforator Flap Breast Reconstruction

Bleeding And Thrombosis In Patients With Out Of Hospital VT/VF Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation

Predicting short-term thromboembolic risk following Roux-en-Y gastric bypass using supervised machine learning

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