Which Patients Require Extended Thromboprophylaxis After Colectomy? Modeling Risk and Assessing Indications for Post-discharge Pharmacoprophylaxis.

Published

Journal Article

Given the conflicting nature of reported risk factors for post-discharge venous thromboembolism (VTE) and unclear guidelines for post-discharge pharmacoprophylaxis, we sought to determine risk factors for 30-day post-discharge VTE after colectomy to predict which patients will benefit from post-discharge pharmacoprophylaxis. Patients who underwent colectomy in the American College of Surgeons National Surgical Quality Improvement Project Participant Use Files from 2011 to 2015 were identified. Logistic regression modeling was used. Receiver-operating characteristic curves were used and the best cut-points were determined using Youden's J index (sensitivity + specificity - 1). Hosmer-Lemeshow goodness-of-fit test was used to test model calibration. A random sample of 30% of the cohort was used as a validation set. Among 77,823 cases, the overall incidence of VTE after colectomy was 1.9%, with 0.7% of VTE events occurring in the post-discharge setting. Factors associated with post-discharge VTE risk including body mass index, preoperative albumin, operation time, hospital length of stay, race, smoking status, inflammatory bowel disease, return to the operating room and postoperative ileus were included in logistic regression equation model. The model demonstrated good calibration (goodness of fit P = 0.7137) and good discrimination (area under the curve (AUC) = 0.68; validation set, AUC = 0.70). A score of ≥-5.00 had the maxim sensitivity and specificity, resulting in 36.63% of patients being treated with prophylaxis for an overall VTE risk of 0.67%. Approximately one-third of post-colectomy VTE events occurred after discharge. Patients with predicted post-discharge VTE risk of ≥-5.00 should be recommended for extended post-discharge VTE prophylaxis.

Full Text

Duke Authors

Cited Authors

  • Beal, EW; Tumin, D; Chakedis, J; Porter, E; Moris, D; Zhang, X-F; Arnold, M; Harzman, A; Husain, S; Schmidt, CR; Pawlik, TM

Published Date

  • July 2018

Published In

Volume / Issue

  • 42 / 7

Start / End Page

  • 2242 - 2251

PubMed ID

  • 29302726

Pubmed Central ID

  • 29302726

Electronic International Standard Serial Number (EISSN)

  • 1432-2323

International Standard Serial Number (ISSN)

  • 0364-2313

Digital Object Identifier (DOI)

  • 10.1007/s00268-017-4447-z

Language

  • eng