Identifying Patients at High Risk for Venous Thromboembolism Requiring Treatment After Outpatient Surgery

Pannucci, Christopher J.; Shanks, Amy; Moote, Marc; Bahl, Vinita; Cederna, Paul S.; Naughton, Norah N.; Wakefield, Thomas W.; Henke, Peter K.; Campbell, Darrell A.; Kheterpal, Sachin

doi:10.1097/sla.0b013e3182519ccf

Cited by 114 publications

(59 citation statements)

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“…The labor-intensive nature of the existing models, which require yes/no answers to between 18 and 40 questions, makes accurate and reliable completion by physicians unlikely. [12][13][14][15] Among the existing risk models that have been developed rigorously from large databases, 8,15 none was able to incorporate VTE-centric risk factors such as a personal or family history of VTE, central venous catheter (CVC), or thrombophilia. The existing risk models were also developed to predict 30-day VTE risk, although studies have shown that the postoperative risk of VTE may extend to 90 days after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…8,14,15 We created a weighted risk score by dividing the b coeffi cient for each predictor with P , .10 by the smallest b coeffi cient of the predictors. This value was rounded to the nearest integer.…”

Section: Risk Model Generationmentioning

confidence: 99%

“…Studies have shown that a 10-to 20-fold difference in VTE risk exists among the overall surgical population. [8][9][10][11] The American College of Chest Physicians (ACCP) guidelines on VTE prevention have long been the standard for conceptualizing VTE risk. 12 The most recent ACCP guidelines, Antithrombotic Therapy and Prevention A nnually, 12 million hospitalized patients are at risk of VTE, which includes DVT and pulmonary embolus (PE).…”

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confidence: 99%

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A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Pannucci¹,

Laird²,

Dimick³

et al. 2014

Chest

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Background: VTE is the proximate cause of 100,000 deaths in the United States each year. Perioperative VTE risk among surgical patients varies by 20-fold, which highlights the importance of risk stratifi cation to identify high-risk patients, in whom chemoprophylaxis can decrease VTE risk, and low-risk patients, for whom the risk-benefi t relationship of prophylaxis may be unfavorable. Methods: We used data from a statewide surgical quality collaborative for surgical procedures performed between 2010 and 2012. Regression-based techniques identifi ed predictors of 90-day VTE while adjusting for procedural complexity and comorbid conditions. A weighted risk index was created and was validated subsequently in a separate, independent dataset. Results: Data were available for 10,344 patients, who were allocated randomly to a derivation or validation cohort. The 90-day VTE rate was 1.4%; 66.2% of the derivation cohort and 65.5% of the validation cohort received chemoprophylaxis. Seven risk factors were incorporated into a weighted risk index: personal history of VTE, current cancer, sepsis/septic shock/systemic infl ammatory response syndrome, age Ն 60 years, BMI Ն 40 kg/m 2 , male sex, and family history of VTE. Prediction for 90-day VTE was similar in the derivation and validation cohorts (areas under the receiver operator curve, 0.72 and 0.70, respectively). An 18-fold variation in 90-day VTE rate was identifi ed. Conclusions: A weighted risk index quantifi es 90-day VTE risk among surgical patients and identifi es an 18-fold variation in VTE risk among the overall surgical population.

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Section: Discussionmentioning

confidence: 99%

Section: Risk Model Generationmentioning

confidence: 99%

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confidence: 99%

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A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Pannucci¹,

Laird²,

Dimick³

et al. 2014

Chest

Self Cite

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“…A number of studies have been published in recent years using the NSQIP to examine VTE rates in general surgery, 41 54 procedures, and factors associated with VTE incidence. Comparing these findings with our analysis, the studies have identified many of the same factors contributing to VTE risk: increased surgery time, dependent functional status, on ventilator ≥ 48 hours postoperatively, return to the operating room, increased age, procedure type, and active cancer.…”

Section: 40mentioning

confidence: 99%

Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy

Kimmell

Jahromi

2015

JNS

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The most recent meta-analysis of VTE prophylaxis in neurosurgical patients concluded abbreviatioNs ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CI = confidence interval; CPT = current procedural terminology; DVT = deep venous thrombosis; MI = myocardial infarction; NSQIP = National Surgical Quality Improvement Program; OR = odds ratio; PE = pulmonary embolism; RCT = randomized controlled trial; SCIP = Surgical Care Improvement Project; TIA = transient ischemic attack; UTI = urinary tract infection; VTE = venous thromboembolism. submitted March 31, 2014. accepted October 22, 2014. iNclude wheN citiNg Published online December 12, 2014; DOI: 10.3171/2014.10.JNS14632. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomyKristopher t. Kimmell, md, and babak s. Jahromi, md, phd Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York obJect Patients undergoing craniotomy are at risk for developing venous thromboembolism (VTE). The safety of anticoagulation in these patients is not clear. The authors sought to identify risk factors predictive of VTE in patients undergoing craniotomy. methods The authors reviewed a national surgical quality database, the American College of Surgeons National Surgical Quality Improvement Program. Craniotomy patients were identified by current procedural terminology code. Clinical factors were analyzed to identify associations with VTE. results Four thousand eight hundred forty-four adult patients who underwent craniotomy were identified. The rate of VTE in the cohort was 3.5%, including pulmonary embolism in 1.4% and deep venous thrombosis in 2.6%. A number of factors were found to be statistically significant in multivariate binary logistic regression analysis, including craniotomy for tumor, transfer from acute care hospital, age ≥ 60 years, dependent functional status, tumor involving the CNS, sepsis, emergency surgery, surgery time ≥ 4 hours, postoperative urinary tract infection, postoperative pneumonia, on ventilator ≥ 48 hours postoperatively, and return to the operating room. Patients were assigned a score based on how many of these factors they had (minimum score 0, maximum score 12). Increasing score was predictive of increased VTE incidence, as well as risk of mortality, and time from surgery to discharge. coNclusioNs Patients undergoing craniotomy are at low risk of developing VTE, but this risk is increased by preoperative medical comorbidities and postoperative complications. The presence of more of these clinical factors is associated with progressively increased VTE risk; patients possessing a VTE Risk Score of ≥ 5 had a greater than 20-fold increased risk of VTE compared with patients with a VTE score of 0.

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“…Risk factors for vte in patients undergoing outpatient surgery include an operative time greater than 120 minutes (or: 1.69; p = 0.027), arthroscopic surgery (or: 5.16; p < 0.001), saphenofemoral junction surgery (or: 13.20; p < 0.001), and venous surgery not involving the great saphenous vein (or: 15.61; p < 0.001) 56 . However, data on the use of anticoagulation in those patients are lacking.…”

Section: Prophylaxis In Patients Undergoing Cancer Surgerymentioning

confidence: 99%

Canadian Consensus Recommendations on the Management of Venous Thromboembolism in Patients with Cancer. Part 1: Prophylaxis

Easaw

Shea‐Budgell

et al. 2015

Current Oncology

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Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic.PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations.Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insufficiency, thrombocytopenia, liver disease, and obesity can warrant modifications in the administration of prophylactic anticoagulant therapy. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, factor Xa levels could be checked at baseline and periodically in patients with renal insufficiency. The use of anticoagulation therapy to prolong survival in cancer patients without the presence of risk factors for vte is not recommended.

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Identifying Patients at High Risk for Venous Thromboembolism Requiring Treatment After Outpatient Surgery

Cited by 114 publications

References 50 publications

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical Patients

Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy

Canadian Consensus Recommendations on the Management of Venous Thromboembolism in Patients with Cancer. Part 1: Prophylaxis

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