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Journal of Gastrointestinal Surgery

, Volume 18, Issue 6, pp 1116–1124 | Cite as

Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

  • Aslam Ejaz
  • Gaya Spolverato
  • Yuhree Kim
  • Donald L. Lucas
  • Brandyn Lau
  • Matthew Weiss
  • Fabian M. Johnston
  • Marian Kheng
  • Kenzo Hirose
  • Christopher L. Wolfgang
  • Elliott Haut
  • Timothy M. PawlikEmail author
Original Article

Abstract

Background

The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is poorly defined, leading to varied use of VTE prophylaxis among surgeons. We sought to define the incidence of VTE after liver surgery and identify risk factors associated with VTE.

Methods

Incidence of VTE and associated risk factors within 90 days of hepatic resection between 2006 and 2012 at a major academic center was analyzed. Risk factors for VTE were identified using univariate and multivariate analyses.

Results

A total of 599 patients were included in the study cohort; 30 (5.0 %) had a prior history of VTE. The indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; n = 402, 67.1 %) while 195 (32.6 %) patients underwent a major hepatectomy (≥3 Couinaud segments). Three hundred seven (51.3 %) patients were started on VTE chemoprophylaxis preoperatively with 407 (67.8 %) patients receiving VTE chemoprophylaxis within 24 h of surgery. Twenty-eight (4.7 %) patients developed VTE; 20 (3.3 %) had deep venous thrombosis (DVT), 11 (1.8 %) had pulmonary embolism (PE), and three (0.5 %) developed both DVT and PE. Among the VTE patients, 23 (82.1 %) had received VTE chemoprophylaxis. On multivariate analyses, history of VTE (odds ratio [OR] 4.51, 95 % confidence interval [CI] 1.81–17.22, P = 0.03), prolonged operative time (OR 1.17 per additional hour, 95 % CI 1.04–1.32, P = 0.009), and increased length of stay (LOS) (OR 1.07, 95 % CI 1.02–1.12, P = 0.01) were independent risk factors for VTE.

Conclusion

VTE within 90 days of hepatic resection is common, occurring in nearly one in 20 patients. Most VTE events occurred among patients who received current best practice prophylaxis for VTE. More aggressive strategies to identify and reduce the risk of VTE in patients at highest risk of VTE, including those with a history of VTE, extended operative time, and prolonged LOS, are warranted.

Keywords

Venous thromboembolism Hepatectomy Prophylaxis Bleeding DVT 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2013

Authors and Affiliations

  • Aslam Ejaz
    • 1
  • Gaya Spolverato
    • 1
  • Yuhree Kim
    • 1
  • Donald L. Lucas
    • 2
  • Brandyn Lau
    • 1
  • Matthew Weiss
    • 1
  • Fabian M. Johnston
    • 1
  • Marian Kheng
    • 1
  • Kenzo Hirose
    • 1
  • Christopher L. Wolfgang
    • 1
  • Elliott Haut
    • 1
  • Timothy M. Pawlik
    • 1
    • 3
    Email author
  1. 1.Department of SurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of SurgeryWalter Reed National Military Medical CenterBethesdaUSA
  3. 3.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA

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