Venous Thromboembolism After Hepatic Resection: Analysis of 5,706 Patients
- 431 Downloads
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.
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.
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.
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.
KeywordsHepatectomy Deep venous thrombosis DVT Pulmonary embolism PE NSQIP Liver resection
- 1.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.PubMedCrossRefGoogle Scholar
- 4.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.PubMedCrossRefGoogle Scholar
- 14.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.CrossRefGoogle Scholar
- 15.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.Google Scholar
- 25.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.PubMedCrossRefGoogle Scholar
- 28.User Guide for the 2009 Participant Use Data File. American College of Surgeons National Surgical Quality Improvement Program. 2010.Google Scholar