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Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

Journal of Gastrointestinal Surgery volume 18, pages 1116–1124 (2014)Cite this article

An Erratum to this article was published on 12 February 2014

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.

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Affiliations

  1. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Aslam Ejaz, Gaya Spolverato, Yuhree Kim, Brandyn Lau, Matthew Weiss, Fabian M. Johnston, Marian Kheng, Kenzo Hirose, Christopher L. Wolfgang, Elliott Haut & Timothy M. Pawlik

  2. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Donald L. Lucas

  3. Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA

    Timothy M. Pawlik

Authors
  1. Aslam Ejaz
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  2. Gaya Spolverato
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  3. Yuhree Kim
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Correspondence to Timothy M. Pawlik.

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Ejaz, A., Spolverato, G., Kim, Y. et al. Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy. J Gastrointest Surg 18, 1116–1124 (2014). https://doi.org/10.1007/s11605-013-2432-x

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Keywords

  • Venous thromboembolism
  • Hepatectomy
  • Prophylaxis
  • Bleeding
  • DVT