Development and Validation of a Risk Calculator for Post-discharge Venous Thromboembolism Following Hepatectomy for Malignancy

Overview

Journal HPB (Oxford)

Publisher Elsevier

Specialty Gastroenterology

Date 2020 Sep 29

PMID 32988755

Citations 3

Authors

Cary Jo R Schlick

Ryan J Ellis

Ryan P Merkow

Anthony D Yang

David J Bentrem

Affiliations

Soon will be listed here.

Abstract

Background: Post-discharge venous thromboembolism (VTE) chemoprophylaxis decreases VTEs following cancer surgery, however identifying high-risk patients remains difficult. Our objectives were to (1) identify factors available at hospital discharge associated with post-discharge VTE following hepatectomy for malignancy and (2) develop and validate a post-discharge VTE risk calculator to evaluate patient-specific risk.

Methods: Patients who underwent hepatectomy for malignancy from 2014 to 2017 were identified from the ACS NSQIP hepatectomy procedure targeted module. Multivariable logistic regression identified factors associated with post-discharge VTE. A post-discharge VTE risk calculator was constructed, and predicted probabilities of post-discharge VTE were calculated.

Results: Among 11 172 patients, 95 (0.9%) developed post-discharge VTE. Post-discharge VTE was associated with obese BMI (OR 2.29 vs. normal BMI [95%CI 1.31-3.99]), right hepatectomy/trisegmentectomy (OR 1.63 vs. partial/wedge [95%CI 1.04-2.57]), and several inpatient postoperative complications: renal insufficiency (OR 5.29 [95%CI 1.99-14.07]), transfusion (OR 1.77 [95%CI 1.12-2.80]), non-operative procedural intervention (OR 2.97 [95%CI 1.81-4.86]), and post-hepatectomy liver failure (OR 2.22 [95%CI 1.21-4.08]). Post-discharge VTE risk ranged from 0.3% to 30.2%. Twenty iterations of 10-fold cross validation identified internal validity.

Conclusions: Risk factors from all phases of care, including inpatient complications, are associated with post-discharge VTE following hepatectomy. Identifying high-risk patients may allow for personalized risk-based post-discharge chemoprophylaxis prescribing.

Citing Articles

Surgical Implications for Nonalcoholic Steatohepatitis-Related Hepatocellular Carcinoma.

Anbarasu C, Williams-Perez S, Camp E, Erstad D Cancers (Basel). 2024; 16(16).

PMID: 39199546 PMC: 11352989. DOI: 10.3390/cancers16162773.

Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery.

Logan C, Hudnall M, Schlick C, French D, Bartle B, Vitello D JAMA Netw Open. 2023; 6(9):e2335311.

PMID: 37768664 PMC: 10539988. DOI: 10.1001/jamanetworkopen.2023.35311.

Post-hepatectomy venous thromboembolism: a systematic review with meta-analysis exploring the role of pharmacological thromboprophylaxis.

Karunakaran M, Kaur R, Ismail S, Cherukuru S, Jonnada P, Senadhipan B Langenbecks Arch Surg. 2022; 407(8):3221-3233.

PMID: 35881311 PMC: 9722838. DOI: 10.1007/s00423-022-02610-9.

References

Gould M, Garcia D, Wren S, Karanicolas P, Arcelus J, Heit J . 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; 141(2 Suppl):e227S-e277S. PMC: 3278061. DOI: 10.1378/chest.11-2297. View

Rasmussen M, Jorgensen L, Wille-Jorgensen P, Nielsen J, Horn A, Mohn A . Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost. 2006; 4(11):2384-90. DOI: 10.1111/j.1538-7836.2006.02153.x. View

Heit J, OFallon W, Petterson T, Lohse C, Silverstein M, Mohr D . Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002; 162(11):1245-8. DOI: 10.1001/archinte.162.11.1245. View

Bilimoria K, Liu Y, Paruch J, Zhou L, Kmiecik T, Ko C . Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013; 217(5):833-42.e1-3. PMC: 3805776. DOI: 10.1016/j.jamcollsurg.2013.07.385. View

Aloia T, Geerts W, Clary B, Day R, Hemming A, DAlbuquerque L . Venous Thromboembolism Prophylaxis in Liver Surgery. J Gastrointest Surg. 2015; 20(1):221-9. DOI: 10.1007/s11605-015-2902-4. View

Newhook T, LaPar D, Walters D, Gupta S, Jolissaint J, Adams R . Impact of Postoperative Venous Thromboembolism on Postoperative Morbidity, Mortality, and Resource Utilization after Hepatectomy. Am Surg. 2016; 81(12):1216-23. View

Rasmussen M, Jorgensen L, Wille-Jorgensen P . Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev. 2009; (1):CD004318. DOI: 10.1002/14651858.CD004318.pub2. View

Parkin L, Sweetland S, Balkwill A, Green J, Reeves G, Beral V . Body mass index, surgery, and risk of venous thromboembolism in middle-aged women: a cohort study. Circulation. 2012; 125(15):1897-904. DOI: 10.1161/CIRCULATIONAHA.111.063354. View

Turley R, Reddy S, Shortell C, Clary B, Scarborough J . Venous thromboembolism after hepatic resection: analysis of 5,706 patients. J Gastrointest Surg. 2012; 16(9):1705-14. DOI: 10.1007/s11605-012-1939-x. View

10.

Aminian A, Andalib A, Khorgami Z, Cetin D, Burguera B, Bartholomew J . Who Should Get Extended Thromboprophylaxis After Bariatric Surgery?: A Risk Assessment Tool to Guide Indications for Post-discharge Pharmacoprophylaxis. Ann Surg. 2016; 265(1):143-150. DOI: 10.1097/SLA.0000000000001686. View

11.

Schlick C, Merkow R, Yang A, Bentrem D . Post-discharge venous thromboembolism after pancreatectomy for malignancy: Predicting risk based on preoperative, intraoperative, and postoperative factors. J Surg Oncol. 2020; 122(4):675-683. PMC: 7755307. DOI: 10.1002/jso.26046. View

12.

Nathan H, Weiss M, Soff G, Stempel M, DeMatteo R, Allen P . Pharmacologic prophylaxis, postoperative INR, and risk of venous thromboembolism after hepatectomy. J Gastrointest Surg. 2013; 18(2):295-302. DOI: 10.1007/s11605-013-2383-2. View

13.

Tzeng C, Katz M, Fleming J, Pisters P, Lee J, Abdalla E . Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications: analysis of 5651 National Surgical Quality Improvement Program patients. HPB (Oxford). 2012; 14(8):506-13. PMC: 3406347. DOI: 10.1111/j.1477-2574.2012.00479.x. View

14.

Shiloach M, Frencher Jr S, Steeger J, Rowell K, Bartzokis K, Tomeh M . Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010; 210(1):6-16. DOI: 10.1016/j.jamcollsurg.2009.09.031. View

15.

Parikh P, Shiloach M, Cohen M, Bilimoria K, Ko C, Hall B . Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB (Oxford). 2010; 12(7):488-97. PMC: 3030758. DOI: 10.1111/j.1477-2574.2010.00216.x. View

16.

Le A, Harris J, Maynard E, Dineen S, Tzeng C . Thromboelastography demonstrates perioperative hypercoagulability in hepato-pancreato-biliary patients and supports routine administration of preoperative and early postoperative venous thromboembolism chemoprophylaxis. HPB (Oxford). 2016; 19(2):154-161. DOI: 10.1016/j.hpb.2016.10.012. View

17.

Lyman G . Venous thromboembolism in the patient with cancer: focus on burden of disease and benefits of thromboprophylaxis. Cancer. 2011; 117(7):1334-49. PMC: 3780385. DOI: 10.1002/cncr.25714. View

18.

Merkow R, Hall B, Cohen M, Dimick J, Wang E, Chow W . Relevance of the c-statistic when evaluating risk-adjustment models in surgery. J Am Coll Surg. 2012; 214(5):822-30. DOI: 10.1016/j.jamcollsurg.2011.12.041. View

19.

Henderson W, Daley J . Design and statistical methodology of the National Surgical Quality Improvement Program: why is it what it is?. Am J Surg. 2009; 198(5 Suppl):S19-27. DOI: 10.1016/j.amjsurg.2009.07.025. View

20.

Cohen M, Bilimoria K, Ko C, Hall B . Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg. 2009; 208(6):1009-16. DOI: 10.1016/j.jamcollsurg.2009.01.043. View