Readmission for Venous Thromboembolism in Emergency General Surgery Patients: A role for Prophylaxis upon Discharge?
*Michael P DeWane, Kevin M Schuster, Adrian A Maung, Kimberly A Davis
Yale School of Medicine, New Haven, CT
Objective: Determine pre- and postoperative risk factors associated with readmission for venous thromboembolism (VTE) after discharge in the emergency general surgery (EGS) population.
Design: Retrospective study of a prospectively gathered cohort.
Setting: Community and Academic Hospitals in the U.S.
Patients: Consecutive sample of patients undergoing select common EGS operations (see Table I) at institutions participating in the American College of Surgeonís National Surgical Quality Improvement Program from 2013-2014.
Main Outcome Measure: Readmission for VTE (defined as either deep vein thrombosis or pulmonary embolism).
Results: A total of 188,696 patients were included in the analysis. The 30-day VTE rate was 1.49%, with 28% of all VTEs occurring after discharge. Multivariable logistic regression modeling was used to determine factors that independently predicted VTE after discharge. The most predictive factors were presence of metastatic cancer (Odds ratio [OR] 2.4, p<0.0001), urinary tract infection (OR 2.3, P<0.0001) and postoperative sepsis (OR 1.5, p=0.0001). These high-risk groups had a rate of readmission due to VTE five times greater than average-risk EGS patients. To achieve risk reduction in line with major surgical oncology patients, the number needed to treat to prevent readmission in high-risk groups was 63.
Conclusions: VTE is a significant cause of readmission in the EGS patient population. Well-defined risk factors were identified in this analysis. This analysis demonstrates that the factors influencing readmission due to VTE differ from previously known risk factors for the development of VTE while hospitalized. In certain at-risk EGS subgroups, prophylactic anticoagulation upon discharge may be beneficial.
|Appendectomy||Lysis of Adhesions|
|Cholecystectomy||Inguinal Hernia Repair|
|Small Bowel Resection||Ventral & Umbilical Hernia Repair|
|Colectomy||Necrotizing Soft Tissue Infection|
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