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. 2021 May;23(5):723-732.
doi: 10.1016/j.hpb.2020.09.008. Epub 2020 Sep 26.

Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy

Cary Jo R Schlick  1 , Ryan J Ellis  2 , Ryan P Merkow  2 , Anthony D Yang  3 , David J Bentrem  4
Affiliations

Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy

Cary Jo R Schlick et al. HPB (Oxford). 2021 May.

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.

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Conflict of interest statement

Conflicts of interest

None declared.

Figures

Figure 1
Figure 1
Predicted probability of post-discharge VTE following hepatectomy for malignancy
See this image and copyright information in PMC

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