BACKGROUND: The fear of an early post-pancreatectomy haemorrhage (PPH) may prevent surgeons from prescribing post-operative venous thromboembolism (VTE) chemoprophylaxis. The primary hypothesis of this study was that the national post-pancreatectomy early PPH rate was lower than the rate of VTE. The secondary hypothesis was that patients at high risk for post-discharge VTE could be identified, potentially facilitating the selective use of extended chemoprophylaxis. PATIENTS AND METHODS: All elective pancreatectomies were identified in the 2005 to 2010 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. Factors associated with 30-day rates of (pre- versus post-discharge) VTE, early PPH (transfusions > 4 units within 72 h) and return to the operating room (ROR) with PPH were analysed. RESULTS: Pancreaticoduodenectomies (PD) and distal pancreatectomies (DP) numbered 9140 (66.4%) and 4631 (33.6%) out of 13 771 pancreatectomies, respectively. Event rates included: VTE (3.1%), PPH (1.1%) and ROR+PPH (0.7%). PD and DP had similar VTE rates (P > 0.05) with 31.9% of VTE occurring post-discharge. Independent risk factors for late VTE included obesity [odds ratio (OR), 1.5], age ≥ 75 years (OR, 1.8), DP (OR, 2.4) and organ space infection (OR, 2.1) (all P < 0.02). CONCLUSIONS: Within current practice patterns, post-pancreatectomy VTE outnumber early haemorrhagic complications, which are rare. The fear of PPH should not prevent routine and timely post-pancreatectomy VTE chemoprophylaxis. Because one-third of VTE occur post-discharge, high-risk patients may benefit from post-discharge chemoprophylaxis.
BACKGROUND: The fear of an early post-pancreatectomy haemorrhage (PPH) may prevent surgeons from prescribing post-operative venous thromboembolism (VTE) chemoprophylaxis. The primary hypothesis of this study was that the national post-pancreatectomy early PPH rate was lower than the rate of VTE. The secondary hypothesis was that patients at high risk for post-discharge VTE could be identified, potentially facilitating the selective use of extended chemoprophylaxis. PATIENTS AND METHODS: All elective pancreatectomies were identified in the 2005 to 2010 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. Factors associated with 30-day rates of (pre- versus post-discharge) VTE, early PPH (transfusions > 4 units within 72 h) and return to the operating room (ROR) with PPH were analysed. RESULTS: Pancreaticoduodenectomies (PD) and distal pancreatectomies (DP) numbered 9140 (66.4%) and 4631 (33.6%) out of 13 771 pancreatectomies, respectively. Event rates included: VTE (3.1%), PPH (1.1%) and ROR+PPH (0.7%). PD and DP had similar VTE rates (P > 0.05) with 31.9% of VTE occurring post-discharge. Independent risk factors for late VTE included obesity [odds ratio (OR), 1.5], age ≥ 75 years (OR, 1.8), DP (OR, 2.4) and organ space infection (OR, 2.1) (all P < 0.02). CONCLUSIONS: Within current practice patterns, post-pancreatectomy VTE outnumber early haemorrhagic complications, which are rare. The fear of PPH should not prevent routine and timely post-pancreatectomy VTE chemoprophylaxis. Because one-third of VTE occur post-discharge, high-risk patients may benefit from post-discharge chemoprophylaxis.
Authors: Giancarlo Agnelli; Giorgio Bolis; Lorenzo Capussotti; Roberto Mario Scarpa; Francesco Tonelli; Erminio Bonizzoni; Marco Moia; Fabio Parazzini; Romina Rossi; Francesco Sonaglia; Bettina Valarani; Carlo Bianchini; Gualberto Gussoni Journal: Ann Surg Date: 2006-01 Impact factor: 12.969
Authors: Caroline E Reinke; Jeffrey A Drebin; Susan Kreider; Craig Kean; Andrew Resnick; Steven Raper; Rachel R Kelz Journal: Ann Surg Oncol Date: 2011-07-02 Impact factor: 5.344
Authors: D Farge; P Debourdeau; M Beckers; C Baglin; R M Bauersachs; B Brenner; D Brilhante; A Falanga; G T Gerotzafias; N Haim; A K Kakkar; A A Khorana; R Lecumberri; M Mandala; M Marty; M Monreal; S A Mousa; S Noble; I Pabinger; P Prandoni; M H Prins; M H Qari; M B Streiff; K Syrigos; H Bounameaux; H R Büller Journal: J Thromb Haemost Date: 2013-01 Impact factor: 5.824
Authors: Thomas A Aloia; Bridget N Fahy; Craig P Fischer; Stephen L Jones; Andrea Duchini; Joseph Galati; A Osama Gaber; R Mark Ghobrial; Barbara L Bass Journal: HPB (Oxford) Date: 2009-09 Impact factor: 3.647
Authors: Nicholas J Skertich; Justin Gerard; Jennifer Poirier; Martin Hertl; Sam G Pappas; Erik Schadde; Xavier M Keutgen Journal: J Gastrointest Surg Date: 2019-01-22 Impact factor: 3.452
Authors: Benjamin Müssle; Nathalie Buck; Stephanie Schade; Marian Sommer; Florian Oehme; Andreas Bogner; Sebastian Hempel; Christoph Radosa; Christoph Kahlert; Marius Distler; Jürgen Weitz; Thilo Welsch Journal: Langenbecks Arch Surg Date: 2020-10-09 Impact factor: 3.445
Authors: Melissa L Bellomy; Milo C Engoren; Barbara J Martin; Yaping Shi; Matthew S Shotwell; Christopher G Hughes; Robert E Freundlich Journal: Anesth Analg Date: 2021-01 Impact factor: 6.627