Distinct predictors of pre‐ versus post‐discharge venous thromboembolism after hepatectomy: analysis of 7621 NSQIP patients

ObjectivesHepatectomy patients are known to be at significant risk for venous thromboembolism (VTE), but previous studies have not differentiated pre‐ versus post‐discharge events. This study was designed to evaluate the timing, rate and predictors of pre‐ (‘early’) versus post‐discharge (‘late’) VTE.MethodsAll patients undergoing elective hepatectomy during 2005–2010 and recorded in the American College of Surgeons National Surgical Quality Improvement Program participant use file were identified. Perioperative factors associated with 30‐day rates of early and late VTE were analysed.ResultsA total of 7621 patients underwent 4553 (59.7%) partial, 802 (10.5%) left, 1494 (19.6%) right and 772 (10.1%) extended hepatectomies. Event rates were 1.9% for deep venous thrombosis, 1.2% for pulmonary embolus and 2.8% for VTE. Of instances of VTE, 28.6% occurred post‐discharge. The median time of presentation of late VTE was postoperative day 14. Multivariate analysis determined that early VTE was associated with age ≥75 years [odds ratio (OR) 1.92, P = 0.007], male gender (OR 1.87, P = 0.002), intraoperative transfusion (OR 2.49, P < 0.001), operative time of >240 min (OR 2.28, P < 0.001), organ space infection (OSI) (OR 2.60, P < 0.001), and return to operating room (ROR) (OR 3.25, P < 0.001). Late VTE was associated with operative time of >240 min (OR 2.35, P = 0.008), OSI (OR 3.78, P < 0.001) and ROR (OR 2.84, P = 0.011).ConclusionsLate VTE events occur in patients with clearly identifiable intraoperative and postoperative risk factors. This provides a rationale for the selective use of post‐discharge VTE chemoprophylaxis in high‐risk patients.