A Propensity-Matched Analysis of the Postoperative Venous Thromboembolism Rate After Pancreatoduodenectomy Based on Operative Approach

Hue, Jonathan J.; Elshami, Mohamedraed; Beckman, Michael J.; Driedger, Michael; Rothermel, Luke D.; Hardacre, Jeffrey M.; Ammori, John B.; Winter, Jordan M.; Ocuin, Lee M.

doi:10.1007/s11605-021-05191-y

Cited by 6 publications

(8 citation statements)

References 55 publications

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“…Despite the absence of protection from EPT in the overall cohort, we did show that MIS pancreatectomy is associated with higher rates of VTE at 90 days compared to the open approach, but that difference is mitigated by the use of EPT; however, the overall significance of this needs to be further studied. Our results demonstrate a comparable rate of VTE to the existing literature, 3,13,14 which suggests the validity of the data set.…”

Section: Data Sharingsupporting

confidence: 83%

“…Recent data from the National Surgical Quality Improvement Program (NSQIP) demonstrate a VTE rate of 2.9% following open and 5.1% following minimally invasive (MIS) pancreaticoduodenectomy. 3 This is likely to be even higher among those undergoing surgery for a diagnosis of PDAC. Not only is the cost burden of VTE significant, 4 but VTE is also associated with increased postoperative complications 5 and worse oncologic outcomes in pancreatic cancer, including decreased survival, 6 likely in part due to the delay to adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Surgery remains the only potentially curative therapy for PDAC, and while the mortality associated with pancreatectomy has decreased, morbidity—including from postoperative VTE—remains high. Recent data from the National Surgical Quality Improvement Program (NSQIP) demonstrate a VTE rate of 2.9% following open and 5.1% following minimally invasive (MIS) pancreaticoduodenectomy 3 . This is likely to be even higher among those undergoing surgery for a diagnosis of PDAC.…”

Section: Introductionmentioning

confidence: 99%

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Extended postoperative thromboprophylaxis after pancreatic resection for pancreatic cancer is associated with decreased risk of venous thromboembolism in the minimally invasive approach

Sood

Kuchta

Paterakos

et al. 2022

Journal of Surgical Oncology

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Background: Pancreatic ductal adenocarcinoma (PDAC) is associated with increased venous thromboembolism (VTE). We sought to compare rates of bleeding complications and VTE in patients receiving extended postoperative thromboprophylaxis (EPT) to those who did not, and identify risk factors for VTE after pancreatectomy for PDAC.Methods: This is a retrospective review of pancreatectomies for PDAC. EPT was defined as 28 days of low molecular weight heparin. Multivariable analysis (MVA) was performed to identify independent risk factors of VTE.Results: Of 269 patients included, 142 (52.8%) received EPT. Of those who received EPT, 7 (4.9%) suffered bleeding complications, compared to 6 (4.7%) of those who did not (p = 0.938). There was no significant difference in VTE rate at 90 days (2.8% vs. 2.4%, p = 0.728) or at 1 year (6.3% vs. 7.9%, p = 0.624). On MVA, risk factors for VTE included worse performance status, lower preoperative hematocrit, R1/R2 resection, and minimally invasive (MIS) approach. Among those who received EPT, there was no difference in VTE rate between MIS and open approach.Conclusions: EPT was not associated with a difference in VTE risk or bleeding complications. MIS approach was associated with a higher risk of VTE; however, this was significantly lower among those who received EPT.

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Section: Data Sharingsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extended postoperative thromboprophylaxis after pancreatic resection for pancreatic cancer is associated with decreased risk of venous thromboembolism in the minimally invasive approach

Sood

Kuchta

Paterakos

et al. 2022

Journal of Surgical Oncology

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“…Extended hepatectomy with extrahepatic bile duct resection or hepatopancreatoduodenectomy is the most invasive, with both a longer operative duration and greater intraoperative blood loss than simple hepatectomy without extrahepatic bile duct resection. Furthermore, both a prolonged operation time and intraoperative blood transfusion are risk factors for VTE in HBP surgery [19][20][21]. Therefore, we assumed that hepatectomy (S4a + S5 resection or hemihepatectomy + caudate lobectomy) with extrahepatic bile duct resection, including hepatopancreatoduodenectomy, was a major risk factor for the development of DVT after HBP surgery.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of perioperative D-dimer concentration for predicting postoperative deep vein thrombosis following hepatobiliary-pancreatic surgery

et al. 2023

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Purpose This study was performed to investigate the predictive value of the perioperative D-dimer concentration for the development of postoperative deep vein thrombosis (DVT) after hepatobiliary-pancreatic (HBP) surgery. Methods The subjects of this retrospective study were 178 patients who underwent HBP surgery in our hospital between January, 2017 and December, 2021. The D-dimer concentration was measured preoperatively and on postoperative days (POD) 1, 3, and 5. Postoperative DVT was diagnosed based on compression ultrasonography in both lower limbs on POD 6 or 7. Results Postoperative DVT developed in 21 (11.8%) of the 178 patients. The D-dimer concentration was significantly higher in the patients with than in those without postoperative DVT before surgery and on PODs 1, 3, and 5. The highest area under the curve of the D-dimer concentration for predicting DVT was 0.762 on POD 3. Multivariate analysis revealed that the D-dimer concentration on POD 3 was an independent predictive risk factor for postoperative DVT, along with the preoperative estimated glomerular filtration rate. Preoperative albumin and D-dimer concentrations were also identified as independent predictive factors of an increase in D-dimer concentration on POD 3. Conclusions The D-dimer concentration on POD 3 is a useful predictor of DVT after HBP surgery.

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“…13 The rate of postoperative VTE following pancreatectomy is ~4%, and is similar after pancreatoduodenectomy (PD) or distal pancreatectomy (DP). [14][15][16] The VTE rate appears to be associated with operative approach (open vs minimally invasive) amongst other patient-specific and operative-specific factors. 14,15 The rate of PPH is ~6% to 8%.…”

mentioning

confidence: 99%

Assessing the use of Extended Venous Thromboembolism Prophylaxis on the Rates of Venous Thromboembolism and Postpancreatectomy Hemorrhage Following Pancreatectomy for Malignancy

et al. 2022

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Objective: To compare rates of venous thromboembolism (VTE) and postpancreatectomy hemorrhage (PPH) in patients with pancreatic or periampullary malignancy preimplementation and postimplementation of routine extended VTE prophylaxis. Background: Guidelines recommend up to 28 days of VTE prophylaxis following major abdominal cancer operations. There is a paucity of data examining rates of VTE and PPH in patients who receive extended VTE prophylaxis following pancreatectomy. Methods: Single-institution analysis of patients who underwent pancreatectomy for malignancy (2004–2021). VTE and PPH rates within 90 days of discharge were compared based on receipt of extended VTE prophylaxis with enoxaparin. Results: A total of 478 patients were included. Twenty-two (4.6%) patients developed a postoperative VTE, 12 (2.5%) of which occurred postdischarge. Twenty-five (5.2%) patients experienced PPH, 13 (2.7%) of which occurred postdischarge. There was no associated difference in the development of postdischarge VTE between patients who received extended VTE prophylaxis and those who did not (2.3% vs 2.8%, P=0.99). There was no associated difference in the rate of postdischarge PPH between patients who received extended VTE prophylaxis and those who did not (3.4% vs 1.9%, P=0.43). In the subset of patients on antiplatelet agents, the addition of enoxaparin did not appear to be associated with higher VTE (3.9 vs. 0%, P=0.31) or PPH (3.0 vs. 4.5%, P=0.64) rates. Conclusions: Extended VTE prophylaxis following pancreatectomy for malignancy was not associated with differences in postdischarge VTE and PPH rates. These data suggest extended VTE prophylaxis is safe but may not be necessary for all patients following pancreatectomy.

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A Propensity-Matched Analysis of the Postoperative Venous Thromboembolism Rate After Pancreatoduodenectomy Based on Operative Approach

Cited by 6 publications

References 55 publications

Extended postoperative thromboprophylaxis after pancreatic resection for pancreatic cancer is associated with decreased risk of venous thromboembolism in the minimally invasive approach

Extended postoperative thromboprophylaxis after pancreatic resection for pancreatic cancer is associated with decreased risk of venous thromboembolism in the minimally invasive approach

Evaluation of perioperative D-dimer concentration for predicting postoperative deep vein thrombosis following hepatobiliary-pancreatic surgery

Assessing the use of Extended Venous Thromboembolism Prophylaxis on the Rates of Venous Thromboembolism and Postpancreatectomy Hemorrhage Following Pancreatectomy for Malignancy

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