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2012 ; 255
(6
): 1093-9
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English Wikipedia
Identifying patients at high risk for venous thromboembolism requiring treatment
after outpatient surgery
#MMPMID22584630
Pannucci CJ
; Shanks A
; Moote MJ
; Bahl V
; Cederna PS
; Naughton NN
; Wakefield TW
; Henke PK
; Campbell DA
; Kheterpal S
Ann Surg
2012[Jun]; 255
(6
): 1093-9
PMID22584630
show ga
OBJECTIVE: To identify independent predictors of 30-day venous thromboembolism
(VTE) events requiring treatment after outpatient surgery. BACKGROUND: An
increasing proportion of surgical procedures are performed in the outpatient
setting. The incidence of VTE requiring treatment after outpatient surgery is
unknown. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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%.