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

Pannucci, Christopher J. MD, MS*; Shanks, Amy MS; Moote, Marc J. PA-C; Bahl, Vinita DMD, MPP§; Cederna, Paul S. MD*; Naughton, Norah N. MD; Wakefield, Thomas W. MD; Henke, Peter K. MD; Campbell, Darrell A. MD; Kheterpal, Sachin MD, MBA

doi: 10.1097/SLA.0b013e3182519ccf
Original Articles

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/m2 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%.

The authors performed a prospective observational cohort study using ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data to examine 30-day venous thromboembolism (VTE) after outpatient surgery. A weighted risk index was created and subsequently validated. The risk index identified a 20-fold variation in 30-day VTE between low (0.06%) and the highest (1.18%) risk patients.

*Section of Plastic Surgery

Department of Anesthesiology

Office of Clinical Affairs

§Clinical Information and Decision Support Services

Section of Vascular Surgery, University of Michigan.

Reprints: Christopher J. Pannucci, MD, MS, Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, MI 48105. E-mail: cpannucc@umich.edu.

Disclosure: Dr Pannucci receives salary support through NIH grant T32 GM-08616. The remaining authors have nothing to disclose.

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© 2012 Lippincott Williams & Wilkins, Inc.