Michael P DeWane1, Kimberly A Davis2, Kevin M Schuster2, Adrian A Maung2, Robert D Becher2. 1. Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT. Electronic address: michael.dewane@yale.edu. 2. Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT.
Abstract
BACKGROUND: Patients undergoing emergency general surgery (EGS) operations experience high rates of venous thromboembolism (VTE). The rates at which thrombus formation occurs after discharge, and whether VTE prophylaxis at discharge might be warranted to prevent readmission, are unknown. This analysis aimed to determine risk factors associated with VTE formation after discharge for EGS operations. STUDY DESIGN: An analysis of the American College of Surgeons NSQIP database from 2013 and 2014 of patients undergoing 10 common EGS operations in an emergent fashion. Multivariable logistic regression modeling was used to determine factors that predicted VTE after discharge. RESULTS: A total of 130,036 patients were included. The 30-day VTE rate was 1.30%, with 35% of all VTEs occurring after discharge. Of those who had VTE develop after discharge, 69.4% required readmission. Predictive factors for post-discharge VTE included prolonged length of stay (odds ratio [OR] 5.25; p < 0.001), 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). Identified high-risk groups had a rate of readmission with thrombus 6 times greater than that of average-risk EGS patients. CONCLUSIONS: More than 30% of VTEs in the EGS population occur after discharge; of these, a vast majority require readmission. Select high-risk EGS subgroups might benefit from prophylactic anticoagulation at discharge.
BACKGROUND:Patients undergoing emergency general surgery (EGS) operations experience high rates of venous thromboembolism (VTE). The rates at which thrombus formation occurs after discharge, and whether VTE prophylaxis at discharge might be warranted to prevent readmission, are unknown. This analysis aimed to determine risk factors associated with VTE formation after discharge for EGS operations. STUDY DESIGN: An analysis of the American College of Surgeons NSQIP database from 2013 and 2014 of patients undergoing 10 common EGS operations in an emergent fashion. Multivariable logistic regression modeling was used to determine factors that predicted VTE after discharge. RESULTS: A total of 130,036 patients were included. The 30-day VTE rate was 1.30%, with 35% of all VTEs occurring after discharge. Of those who had VTE develop after discharge, 69.4% required readmission. Predictive factors for post-discharge VTE included prolonged length of stay (odds ratio [OR] 5.25; p < 0.001), 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). Identified high-risk groups had a rate of readmission with thrombus 6 times greater than that of average-risk EGSpatients. CONCLUSIONS: More than 30% of VTEs in the EGS population occur after discharge; of these, a vast majority require readmission. Select high-risk EGS subgroups might benefit from prophylactic anticoagulation at discharge.
Authors: Jessica C Cardenas; Yao-Wei Wang; Jay V Karri; Seenya Vincent; Andrew P Cap; Bryan A Cotton; Charles E Wade Journal: Thromb Res Date: 2020-01-15 Impact factor: 3.944
Authors: Samuel W Ross; Kali M Kuhlenschmidt; John C Kubasiak; Lindsey E Mossler; Luis R Taveras; Thomas H Shoultz; Herbert A Phelan; Caroline E Reinke; Michael W Cripps Journal: JAMA Surg Date: 2020-06-01 Impact factor: 14.766
Authors: Belinda De Simone; Elie Chouillard; Almino C Ramos; Gianfranco Donatelli; Tadeja Pintar; Rahul Gupta; Federica Renzi; Kamal Mahawar; Brijesh Madhok; Stefano Maccatrozzo; Fikri M Abu-Zidan; Ernest E Moore; Dieter G Weber; Federico Coccolini; Salomone Di Saverio; Andrew Kirkpatrick; Vishal G Shelat; Francesco Amico; Emmanouil Pikoulis; Marco Ceresoli; Joseph M Galante; Imtiaz Wani; Nicola De' Angelis; Andreas Hecker; Gabriele Sganga; Edward Tan; Zsolt J Balogh; Miklosh Bala; Raul Coimbra; Dimitrios Damaskos; Luca Ansaloni; Massimo Sartelli; Nikolaos Parasas; Yoram Kluger; Elias Chahine; Vanni Agnoletti; Gustavo Fraga; Walter L Biffl; Fausto Catena Journal: World J Emerg Surg Date: 2022-09-27 Impact factor: 8.165