Juan I. Arcelus, MD, PhD
Does a risk stratification model predict venous thromboembolism (VTE) events requiring treatment after outpatient surgery?
Registry-based cohort study for derivation and validation of a risk prediction index.
American College of Surgeons' National Surgical Quality Improvement Program Participant Use File (ACS-NSQIP) database.
259 231 patients who had outpatient surgery with a length of stay of 0 days (same-day surgery, ≤ 23 hours of observation after surgery), randomly assigned to derivation (n = 173 501, 58% women) and validation (n = 85 730) cohorts.
The weighted risk index included age 40 to 59 years, operating room time ≥ 120 minutes, and body mass index ≥ 40 kg/m2 (2 points each); age ≥ 60 years (3 points); active cancer (5 points); arthroscopic surgery (6 points); current pregnancy (8 points); saphenofemoral junction surgery (10 points); and non–great saphenous vein venous surgery (11 points).
VTE (deep venous thrombosis or pulmonary embolism) requiring treatment within 30 days of surgery.
The most common primary procedure types in the derivation cohort were herniorrhaphy (33%); integument (22%); liver, biliary system, and pancreas (13%); and musculoskeletal (9%). 254 patients (0.15%) in the derivation cohort and 112 patients (0.13%) in the validation cohort had incident VTE. In the derivation cohort, the median time to VTE was 8 days; 0.06% and 1.18% of patients identified as low and high risk, respectively, by the weighted risk index had VTE within 30 days. The areas under the receiver-operating characteristic curve for the weighted risk index were 0.76 in the derivation cohort and 0.78 in the validation cohort.
A weighted risk index had moderate ability to predict venous thromboembolism events requiring treatment after outpatient surgery.
Arcelus JI. A weighted risk index had moderate ability to predict VTE requiring treatment after outpatient surgery. Ann Intern Med. ;158:JC12. doi: 10.7326/0003-4819-158-4-201302190-02012
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Published: Ann Intern Med. 2013;158(4):JC12.
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