Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications

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dc.contributor.author Tzeng, Ching-Wei
dc.contributor.author Katz, Matthew
dc.contributor.author Fleming, Jason
dc.contributor.author Pisters, Peter
dc.contributor.author Lee, Jeffrey
dc.contributor.author Abdalla, Eddie
dc.contributor.author Curley, Steven
dc.contributor.author Vauthey, Jean-Nicolas
dc.contributor.author Aloia, Thomas
dc.date.accessioned 2015-11-20T10:26:52Z
dc.date.available 2015-11-20T10:26:52Z
dc.date.copyright 2012
dc.date.issued 2015-11-20
dc.identifier.issn 1365-182X en_US
dc.identifier.uri http://hdl.handle.net/10725/2651
dc.description.abstract Background: Historically, liver surgeons have withheld venous thromboembolism (VTE) chemoprophylaxis due to perceived postoperative bleeding risk and theorized protective anticoagulation effects of a hepatectomy. The relationships between extent of hepatectomy, postoperative VTE and bleeding events were evaluated using the National Surgical Quality Improvement Program (NSQIP) database. Methods: From 2005 to 2009, all elective open hepatectomies were identified. Factors associated with 30-day rates of VTE, postoperative transfusions and returns to the operating room (ROR), were analysed. Results: The analysis included 5651 hepatectomies with 3376 (59.7%) partial, 585 (10.4%) left, 1134 (20.1%) right, and 556 (9.8%) extended. Complications included deep vein thrombosis (DVT) (1.93%), pulmonary embolism (PE) (1.31%), venous thromboembolism (VTE) (2.88%), postoperative transfusion (0.76%) and ROR with transfusion (0.44%). VTE increased with magnitude of hepatectomy (partial 2.13%, left 2.05%, right 4.15%, extended 5.76%; P < 0.001) and outnumbered bleeding events (P < 0.001). Other factors independently associated with VTE were aspartate aminotransferase (AST) 27 (P = 0.022), American Society of Anesthesiologists (ASA) class 3 (P < 0.001), operative time >222 min (P = 0.043), organ space infection (P < 0.001) and length of hospital stay 7 days (P = 0.004). VTE resulted in 30-day mortality of 7.4% vs. 2.3% with no VTE (P = 0.001). Conclusions: Contrary to the belief that transient postoperative liver insufficiency is protective, VTE increases with extent of hepatectomy. VTE exceeds major bleeding events and is strongly associated with mortality. These data support routine post-hepatectomy VTE chemoprophylaxis. en_US
dc.language.iso en en_US
dc.title Risk of venous thromboembolism outweighs post-hepatectomy bleeding complications en_US
dc.type Article en_US
dc.description.version Published en_US
dc.title.subtitle Analysis of 5651 National Surgical Quality Improvement Program patients en_US
dc.author.school SOM en_US
dc.author.idnumber 201100945 en_US
dc.author.woa N/A en_US
dc.author.department N/A en_US
dc.description.embargo N/A en_US
dc.relation.journal HPB en_US
dc.journal.volume 14 en_US
dc.journal.issue 8 en_US
dc.article.pages 506-513 en_US
dc.keywords Liver en_US
dc.keywords Hepatectomy en_US
dc.keywords Venous thomboembolism en_US
dc.keywords Deep venous thrombosis en_US
dc.identifier.doi http://dx.doi.org/10.1111/j.1477-2574.2012.00479.x en_US
dc.identifier.ctation Tzeng, C. W. D., Katz, M. H., Fleming, J. B., Pisters, P. W., Lee, J. E., Abdalla, E. K., ... & Aloia, T. A. (2012). Risk of venous thromboembolism outweighs post‐hepatectomy bleeding complications: analysis of 5651 National Surgical Quality Improvement Program patients. HPB, 14(8), 506-513. en_US
dc.author.email eddie.abdalla@lau.edu.lb
dc.identifier.url http://onlinelibrary.wiley.com/doi/10.1111/j.1477-2574.2012.00479.x/full

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