Identifying Patients at High Risk for Venous Thromboembolism Requiring Treatment After Outpatient Surgery

Section of Plastic Surgery, University of Michigan, Ann Arbor, MI 48105, USA.
Annals of surgery (Impact Factor: 8.33). 06/2012; 255(6):1093-9. DOI: 10.1097/SLA.0b013e3182519ccf
Source: PubMed


To identify independent predictors of 30-day venous thromboembolism (VTE) events requiring treatment after outpatient surgery.
An increasing proportion of surgical procedures are performed in the outpatient setting. The incidence of VTE requiring treatment after outpatient surgery is unknown.
Prospective observational cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2009. Adult patients who had outpatient surgery or surgery with subsequent 23-hour observation were included. The main outcome measure was 30-day VTE requiring treatment. Patients were randomly assigned to derivation (N = 173,501) or validation (N = 85,730) cohorts. Logistic regression examined independent risk factors for 30-day VTE. A weighted risk index was created and applied to the validation cohort. Stratified analyses examined 30-day VTE by risk level.
Thirty-day incidence of VTE for the overall cohort was 0.15%. Independent risk factors included current pregnancy (adjusted odds ratio [OR] = 7.80, P = 0.044), active cancer (OR = 3.66, P = 0.005), age 41 to 59 years (OR = 1.72, P = 0.008), age 60 years or more (OR = 2.48, P < 0.001), body mass index 40 kg/m or higher (OR = 1.81, P = 0.015), operative time 120 minutes or more (OR = 1.69, P = 0.027), arthroscopic surgery (OR = 5.16, P < 0.001), saphenofemoral junction surgery (OR = 13.20, P < 0.001), and venous surgery not involving the great saphenous vein (OR = 15.61, P < 0.001). The weighted risk index identified a 20-fold variation in 30-day VTE between low (0.06%) and highest risk (1.18%) patients.
Thirty-day VTE risk after outpatient surgery can be quantified using a weighted risk index. The risk index identifies a high-risk subgroup of patients with 30-day VTE rates of 1.18%.

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Available from: Christopher Pannucci, Sep 07, 2014
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    • "One cohort study [28] has shown that age over 40, uncontrolled cancer and duration of operation over 120 min were independent risk factors for the onset of TE events within 30 days of ambulatory surgery. Higher risk surgeries include orthopedic (arthroscopic) and peripheral vascular surgery [28]. "
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