Incidence and Cost of Deep Vein Thrombosis in Emergency General Surgery Over 15 Years

Gantz, Owen; Mulles, Shanen; Zagadailov, Pavel; Merchant, Aziz M.

doi:10.1016/j.jss.2020.03.022

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…Following emergency surgery, we found an annual reduction in VTE risk following minimally invasive benign resections and a year‐on‐year increase in VTE risk post open malignant colorectal resections. This contrasts with contemporary data reporting no differences in annual VTE risk following emergency colectomy [ 62 ]. Although the smaller numbers for emergency minimally invasive procedures mean their trends are underpowered, this again highlights that extended VTE prophylaxis alone might not be able to compensate for other developments in perioperative care.…”

Section: Discussioncontrasting

confidence: 76%

“…This contrasts with contemporary data reporting no differences in annual VTE risk following emergency colectomy [62]. Although the smaller numbers for emergency minimally invasive procedures mean their trends are underpowered, this again highlights that extended VTE prophylaxis alone might not be able to compensate for other developments in perioperative care.…”

Section: Emergency Colorectal Resection Vte Risksmentioning

confidence: 64%

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Time trends in the incidence rates of venous thromboembolism following colorectal resection by indication and operative technique

et al. 2022

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Aim It is important for patient safety to assess if international changes in perioperative care, such as the focus on venous thromboembolism (VTE) prevention and minimally invasive surgery, have reduced the high post colectomy VTE risks previously reported. This study assesses the impact of changes in perioperative care on VTE risk following colorectal resection. Method This was a population‐based cohort study of colectomy patients in England between 2000 and 2019 using a national database of linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Within 30 days following colectomy, absolute VTE rates per 1000 person‐years and adjusted incidence rate ratios (aIRRs) using Poisson regression for the per year change in VTE risk were calculated. Results Of 183 791 patients, 1337 (0.73%) developed 30‐day postoperative VTE. Overall, VTE rates reduced over the 20‐year study period following elective (relative risk reduction 31.25%, 95% CI 5.69%–49.88%) but not emergency surgery. Similarly, yearly changes in VTE risk reduced following minimally invasive resections (elective benign, aIRR 0.93, 95% CI 0.90–0.97; elective malignant, aIRR 0.94, 95% CI 0.91–0.98; and emergency benign, aIRR 0.96, 95% CI 0.92–1.00) but not following open resections. There was a per year VTE risk increase following open emergency malignant resections (aIRR 1.02, 95% CI 1.00–1.04). Conclusion Yearly VTE risks reduced following minimally invasive surgeries in the elective setting yet in contrast were static following open elective colectomies, and following emergency malignant resections increased by almost 2% per year. To reduce VTE risk, further efforts are required to implement advances in surgical care for those having emergency and/or open surgery.

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Section: Discussioncontrasting

confidence: 76%

Section: Emergency Colorectal Resection Vte Risksmentioning

confidence: 64%

Time trends in the incidence rates of venous thromboembolism following colorectal resection by indication and operative technique

et al. 2022

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“…Only one study assessed specific chemotherapeutics, indicating the critical need for more trials for EGS patients by assessing VTE prophylaxis and its efficacy. Despite these limitations, we recommend that VTE chemoprophylaxis in trauma patients is beneficial (Gantz et al, 2020). There seems to be no difference between LMWH (especially enoxaparin), UFH, and DOACs.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Chemoprophylaxis in Trauma and Emergency General Surgery Patients: A Systematic Review

Sanchez

Nguyen

Baroutjian

et al. 2021

Journal of Trauma Nursing

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Background: Appropriate venous thromboembolism (VTE) chemoprophylaxis in trauma and emergency general surgery (EGS) patients is crucial. Objective: The purpose of this study is to review the recent literature and offer recommendations for VTE chemoprophylaxis in trauma and EGS patients. Methods: We conducted a literature search from 2000 to 2021 for articles investigating VTE chemoprophylaxis in adult trauma and EGS patients. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Results: Our search resulted in 34 articles. Most studies showed low-molecular-weight heparin (LMWH) is similar to unfractionated heparin (UFH) for VTE prevention; however, LMWH was more commonly used. Adjusted chemoprophylaxis dosing did not change the VTE rate but the timing did. Direct oral anticoagulants (DOACs) have been shown to be safe and effective in trauma and traumatic brain injury (TBI)/spinal cord injury (SCI). Studies showed VTE prophylaxis in EGS can be inconsistent and improves with guidelines that lower VTE events. Conclusions: There may be no benefit to receiving LMWH over UFH in trauma patients. In addition, different drugs under the class of LMWH do not change the incidence of VTE. Adjusted dosing of enoxaparin does not seem to affect VTE incidence. The use of DOACs in the trauma TBI and SCI setting has been shown to be safe and effective in reducing VTE. One important consideration with VTE prophylaxis may be the timing of prophylaxis initiation, specifically as it relates to TBI, with a higher likelihood of developing VTE as time progresses. EGS patients are at a high risk of VTE. Improved compliance with clinical guidelines in this population is correlated with decreased thrombotic events.

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“…Although the latest version of the guidelines for the diagnosis and treatment of DVT (Third edition) in China affirms the role of mechanical and drug prevention, according to the investigation on the implementation status of DVT risk assessment and prevention in general surgery conducted by Shanghai DVT prevention and control alliance in 2019, the risk assessment rate of DVT in general surgery is only 61.9%, It can be reflected from the side that the risk assessment and prevention implementation of DVT in China need to be further improved ( 27 ).…”

Section: Resultsmentioning

confidence: 99%

The Best Evidence for the Prevention and Management of Lower Extremity Deep Venous Thrombosis After Gynecological Malignant Tumor Surgery: A Systematic Review and Network Meta-Analysis

Geng

et al. 2022

Front. Surg.

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Background:To search and obtain the relevant evidence of prevention and management of lower extremity deep venous thrombosis (DVT) after gynecological malignant tumor operation and to summarize the relevant evidence.MethodsWe searched the JBI evidence summary, up to date, the national comprehensive cancer network of the United States, the guide library of the National Institute of clinical medicine of the United Kingdom, PubMed, the Chinese biomedical literature database, CNKI, Wanfang, and other relevant evidence on the prevention and management of DVT in patients with gynecological malignant tumors. It includes clinical practice guidelines, best practice information book, expert consensus, evidence summary, original research, etc. The retrieval time limit is from database establishment till August 20, 2021. Two researchers independently evaluated the literature quality, combined with professional judgment, and extracted the literature that met the standards.ResultsFinally, 18 literatures were included, including eight guidelines, three evidence summaries, four systematic evaluations, two expert consensuses, and one best practice information volume. A total of 26 pieces of the best evidence on the prevention and management of postoperative venous thrombosis in gynecological malignant tumors were summarized. It includes risk assessment, drug prevention, mechanical prevention, management strategy, and health education.ConclusionThis study summarized the best evidence of risk, prevention, and health management of DVT in postoperative patients with gynecological malignant tumors to provide evidence-based basis for clinical nurses and to improve the nursing level.

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Incidence and Cost of Deep Vein Thrombosis in Emergency General Surgery Over 15 Years

Cited by 12 publications

References 29 publications

Time trends in the incidence rates of venous thromboembolism following colorectal resection by indication and operative technique

Time trends in the incidence rates of venous thromboembolism following colorectal resection by indication and operative technique

Venous Thromboembolism Chemoprophylaxis in Trauma and Emergency General Surgery Patients: A Systematic Review

The Best Evidence for the Prevention and Management of Lower Extremity Deep Venous Thrombosis After Gynecological Malignant Tumor Surgery: A Systematic Review and Network Meta-Analysis

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