Identification of patients at high risk for post-discharge venous thromboembolism after hepato-pancreato-biliary surgery: which patients benefit from extended thromboprophylaxis?


Journal Article

BACKGROUND:The objective of the current study was to define risk factors associated with the 30-day post-operative risk of VTE after HPB surgery and create a model to identify patients at highest risk of post-discharge VTE. METHODS:Patients who underwent hepatectomy or pancreatectomy in the ACS-NSQIP Participant Use Files 2011-2015 were identified. Logistic regression modeling was used; a model to predict post-discharge VTE was developed. Model discrimination was tested using area under the curve (AUC). RESULTS:Among 48,860 patients, the overall 30-day incidence of VTE after hepatectomy and pancreatectomy was 3.2% (n = 1580) with 1.1% (n = 543) of VTE events occurring after discharge. Patients who developed post-discharge VTE were more likely to be white, had a higher median BMI, have undergone pancreatic surgery, had longer median operative times, and to have had a transfusion. A weighted prediction model demonstrated good calibration and fair discrimination (AUC = 0.63). A score of ≥-4.50 had maximum sensitivity and specificity, resulting in 44% of patients being treating with prophylaxis for an overall VTE risk of 1.1%. CONCLUSIONS:Utilizing independent factors associated with post-discharge VTE, a prediction model was able to stratify patients according to risk of VTE and may help identify patients who are most likely to benefit from pharmacoprophylaxis.

Full Text

Duke Authors

Cited Authors

  • Beal, EW; Tumin, D; Chakedis, J; Porter, E; Moris, D; Zhang, X-F; Abdel-Misih, S; Dillhoff, M; Manilchuk, A; Cloyd, J; Schmidt, CR; Pawlik, TM

Published Date

  • July 2018

Published In

Volume / Issue

  • 20 / 7

Start / End Page

  • 621 - 630

PubMed ID

  • 29472105

Pubmed Central ID

  • 29472105

Electronic International Standard Serial Number (EISSN)

  • 1477-2574

International Standard Serial Number (ISSN)

  • 1365-182X

Digital Object Identifier (DOI)

  • 10.1016/j.hpb.2018.01.004


  • eng