Venous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge?

DeWane, Michael P.; Davis, Kimberly A.; Schuster, Kevin M.; Maung, Adrian A.; Becher, Robert D.

doi:10.1016/j.jamcollsurg.2018.03.021

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…However, the risk of hospital-associated VTE extends from the time of admission and over the first 90 days post hospital discharge also in COVID-19 patients. [2] , [3] , [4] , [5] , [6] . To this regard, the actual post-discharge cumulative incidence of VTE events in patients hospitalized for COVID-19 pneumonia has not been clearly determined, limiting the formulation of clinical recommendations regarding the need for and optimal duration of extended thromboprophylaxis strategies.…”

Section: Introductionmentioning

confidence: 99%

Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: A systematic review and meta-analysis

Zuin

Engelen

Barco

et al. 2022

Thrombosis Research

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Section: Introductionmentioning

confidence: 99%

Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: A systematic review and meta-analysis

Zuin

Engelen

Barco

et al. 2022

Thrombosis Research

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“…DeWane et al [ 115 ] retrospectively analyzed 130,036 patients in the American College of Surgeons NSQIP database who underwent emergency surgery and reported that more than 30% of VTEs occur after discharge and that the majority of these patients required readmission. Predictive factors for post-discharge VTE included prolonged length of stay (odds ratio [OR] 5.25; p < 0.001), the presence of metastatic cancer (OR 2.23; p < 0.001), urinary tract infection (OR 1.91; p < 0.001), and postoperative sepsis (OR 1.55; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

et al. 2022

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Background Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.

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“…Instigating factors such as the presence of central venous catheters, delays in starting VTE prophylaxis, and the lack of ambulation likely contribute to greater risk of VTE following complex operations. 1,13 Whether this relationship is truly attributable to VTE or represents other coexisting conditions, merits further investigation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Venous Thromboembolism on Readmissions and Resource Use Following Emergency General Surgery

Hadaya

Ebrihiminan

et al. 2022

The American Surgeon

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Background Acute deep vein thrombosis and pulmonary embolism collectively known as venous thromboembolism (VTE), are associated with increased risk of poor clinical sequelae during inpatient hospitalizations. We examined the association of VTE with mortality, readmissions, and costs among patients undergoing emergency general surgery (EGS) operations using a national cohort. Methods Adult hospitalizations for EGS (laparotomy, small bowel resection, large bowel resection, appendectomy, lysis of adhesions, cholecystectomy, and repair of perforated ulcer) within two days of admission were identified in the 2016-18 Nationwide Readmissions Database. Hospitalizations were stratified based on diagnosis of VTE and others (n-VTE). Results Of an estimated 860, 747 ;27,700;23,100;28,300 EGS patients, .87% developed VTE during the index hospitalization. Patients in the VTE group were on average older (65.5 ± 15.3 vs 54.8 ± 18.6 years, P < .001) and more commonly male (46.7 vs 39.3%, P < .001). Venous thromboembolism was independently associated with greater odds of mortality (AOR:1.7 95% CI 1.6-1.9), increased costs ( +27 700 95% CI 23 100-28 300) and greater odds of 30-day readmissions (AOR 1.3 95% CI 1.2-1.4). Discussion Despite national efforts to reduce its incidence, VTE affects nearly 1/100 EGS patients and is associated with increased odds of mortality as well as costs, and readmissions. Tailored approaches are warranted to reduce the impact of this pernicious complication.

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Venous Thromboembolism-Related Readmission in Emergency General Surgery Patients: A Role for Prophylaxis on Discharge?

Cited by 16 publications

References 19 publications

Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: A systematic review and meta-analysis

Incidence of venous thromboembolic events in COVID-19 patients after hospital discharge: A systematic review and meta-analysis

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Impact of Venous Thromboembolism on Readmissions and Resource Use Following Emergency General Surgery

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