Abstract
Objective
The routine use of venous thromboembolism (VTE) chemoprophylaxis after hepatic surgery remains controversial due to the relatively low incidence of this complication and the significant risk of perioperative bleeding. The objective of our analysis was to identify perioperative predictors of postoperative VTE in patients undergoing resection.
Methods
All patients from the American College of Surgeons National Surgical Quality Improvement Program Participant User File from 2005 to 2009 who underwent hepatic resection were included for analysis. Forward stepwise multivariate logistic regression models were used to determine perioperative variables that are significantly associated with VTE after hepatic surgery.
Results
The overall incidence of VTE after hepatic resection was 2.9 %. Significant predictors of VTE after hepatic resection included preoperative mechanical ventilation, male gender, operative time > 3 h, age ≥ 70 years, intraoperative transfusion, and extended hepatectomy. Several non-VTE postoperative complications were also associated with subsequent VTE, including prolonged mechanical ventilation, need for early reoperation, and postoperative bleeding.
Conclusions
Many perioperative factors, including extended hepatectomy as well as several postoperative non-VTE complications, are associated with an increased risk of VTE after hepatic resection. Knowledge of these factors may assist surgeons in deciding which patients merit more aggressive prophylaxis against this complication.
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References
Turpie AG, Bauer KA, Caprini JA, Comp PC, Gent M, Muntz JE. Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison. J Thromb Haemost. 2007 Sep;5(9):1854-61.
Mismetti P, Laporte S, Darmon JY, Buchmuller A, Decousus H. Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery. Br J Surg. 2001 Jul;88(7):913-30.
Samama CM, Albaladejo P, Benhamou D, Bertin-Maghit M, Bruder N, Doublet JD, et al. Venous thromboembolism prevention in surgery and obstetrics: clinical practice guidelines. Eur J Anaesthesiol. 2006 Feb;23(2):95-116.
Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med. 1988 May 5;318(18):1162-73.
Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg. 1988 Aug;208(2):227-40.
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):381 S-453 S.
Kakkar AK, Levine M, Pinedo HM, Wolff R, Wong J. Venous thrombosis in cancer patients: insights from the FRONTLINE survey. Oncologist. 2003;8(4):381-8.
Agnelli G, Bolis G, Capussotti L, Scarpa RM, Tonelli F, Bonizzoni E, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg. 2006 Jan;243(1):89-95.
Blom JW, Vanderschoot JP, Oostindier MJ, Osanto S, van der Meer FJ, Rosendaal FR. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost. 2006 Mar;4(3):529-35.
Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006 Feb 27;166(4):458-64.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ, 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000 Mar 27;160(6):809-15.
Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. Jama. 2005 Feb 9;293(6):715-22.
Sakon M, Maehara Y, Yoshikawa H, Akaza H. Incidence of venous thromboembolism following major abdominal surgery: a multi-center, prospective epidemiological study in Japan. J Thromb Haemost. 2006 Mar;4(3):581-6.
Mukherjee D, Lidor AO, Chu KM, Gearhart SL, Haut ER, Chang DC. Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2008 Nov;12(11):2015-22.
Reddy SK, Turley RS, Barbas AS, Steel JL, Tsung A, Marsh JW, et al. Post-Operative Pharmacologic Thromboprophylaxis after Major Hepatectomy : Does Peripheral Venous Thromboembolism Prevention Outweigh Bleeding Risks? J Gastrointest Surg. 2011 Jun 21.
Schroeder RA, Marroquin CE, Bute BP, Khuri S, Henderson WG, Kuo PC. Predictive indices of morbidity and mortality after liver resection. Ann Surg. 2006 Mar;243(3):373-9.
Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002 Oct;236(4):397-406; discussion -7.
Morris-Stiff G, White A, Gomez D, Toogood G, Lodge JP, Prasad KR. Thrombotic complications following liver resection for colorectal metastases are preventable. HPB (Oxford). 2008;10(5):311-4.
Stewart GD, O’Suilleabhain CB, Madhavan KK, Wigmore SJ, Parks RW, Garden OJ. The extent of resection influences outcome following hepatectomy for colorectal liver metastases. Eur J Surg Oncol. 2004 May;30(4):370-6.
Yates TJ, Abouljoud M, Lambing A, Kuriakose P. Risk of venous thrombosis in patients with hepatic malignancies undergoing surgical resection. Indian J Gastroenterol. 2008 Jul-Aug;27(4):159-61.
Lo CM. Complications and long-term outcome of living liver donors: a survey of 1,508 cases in five Asian centers. Transplantation. 2003 Feb 15;75(3 Suppl):S12-5.
Broering DC, Wilms C, Bok P, Fischer L, Mueller L, Hillert C, et al. Evolution of donor morbidity in living related liver transplantation: a single-center analysis of 165 cases. Ann Surg. 2004 Dec;240(6):1013-24; discussions 24-6.
Marsh JW, Gray E, Ness R, Starzl TE. Complications of right lobe living donor liver transplantation. J Hepatol. 2009 Oct;51(4):715-24.
Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol. 2007 Dec 1;25(34):5490-505.
Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e227S-77 S.
Rogers SO, Jr., Kilaru RK, Hosokawa P, Henderson WG, Zinner MJ, Khuri SF. Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery: results from the patient safety in surgery study. J Am Coll Surg. 2007 Jun;204(6):1211-21.
Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005 Feb-Mar;51(2-3):70-8.
User Guide for the 2009 Participant Use Data File. American College of Surgeons National Surgical Quality Improvement Program. 2010.
Strebel N, Prins M, Agnelli G, Buller HR. Preoperative or postoperative start of prophylaxis for venous thromboembolism with low-molecular-weight heparin in elective hip surgery? Arch Intern Med. 2002 Jul 8;162(13):1451-6.
Aloia TA, Fahy BN, Fischer CP, Jones SL, Duchini A, Galati J, et al. Predicting poor outcome following hepatectomy: analysis of 2313 hepatectomies in the NSQIP database. HPB (Oxford). 2009 Sep;11(6):510-5.
Ito H, Are C, Gonen M, D’Angelica M, Dematteo RP, Kemeny NE, et al. Effect of postoperative morbidity on long-term survival after hepatic resection for metastatic colorectal cancer. Ann Surg. 2008 Jun;247(6):994-1002.
Dondero F, Taille C, Mal H, Sommacale D, Sauvanet A, Farges O, et al. Respiratory complications: a major concern after right hepatectomy in living liver donors. Transplantation. 2006 Jan 27;81(2):181-6.
Umeshita K, Fujiwara K, Kiyosawa K, Makuuchi M, Satomi S, Sugimachi K, et al. Operative morbidity of living liver donors in Japan. Lancet. 2003 Aug 30;362(9385):687-90.
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Turley, R.S., Reddy, S.K., Shortell, C.K. et al. Venous Thromboembolism After Hepatic Resection: Analysis of 5,706 Patients. J Gastrointest Surg 16, 1705–1714 (2012). https://doi.org/10.1007/s11605-012-1939-x
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DOI: https://doi.org/10.1007/s11605-012-1939-x