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Surgery. 2015 Nov;158(5):1304-13. doi: 10.1016/j.surg.2015.04.001. Epub 2015 May 7.

Creation and validation of a condition-specific venous thromboembolism risk assessment tool for ventral hernia repair.

Author information

1
Division of Plastic Surgery, University of Utah, Salt Lake City, UT. Electronic address: Christopher.Pannucci@hsc.utah.edu.
2
Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA.

Abstract

BACKGROUND:

We used the database of the American College of Surgeons National Surgical Quality Improvement Program to (1) identify risk factors for 30-day venous thromboembolism (VTE) after ventral hernia repair (VHR) and (2) to create and validate a condition-specific assessment tool for the risk of VTE.

METHODS:

Open and laparoscopic VHR patients in the American College of Surgeons National Surgical Quality Improvement Program were identified using Current Procedural Terminology code. The occurrence of VTE, including deep-venous thrombosis (DVT) or pulmonary embolus, within 30 days postoperatively was the primary outcome. Regression-based analysis and subsequent bootstrap analysis created a weighted VTE risk assessment model (RAM) for ventral hernia repair. The weighted RAM was used to risk-stratify patients for both 30-day VTE risk and 30-day risk for medical and surgical complications.

RESULTS:

Data for 113,873 hernia repair patients were obtained; 30-day deep-venous thrombosis, pulmonary embolus, and VTE rates were 0.59%, 0.43%, and 0.92%, respectively. The average time to VTE was 10.8 days. A 14-factor, weighted RAM was created. The weighted risk score identified a 25-fold variability (from 0.20 to 4.97%) in VTE risk among the overall VHR population. Although created to risk-stratify for VTE, the risk score also risk-stratified for 30-day medical and surgical complications, inpatient duration of stay, and 30-day mortality.

CONCLUSION:

The 30-day VTE risk after VHR is 0.92%, but a 25-fold variability in VTE risk exists among the overall hernia population. We demonstrate that a weighted VTE RAM quantifies VTE risk among the population undergoing ventral hernia repair, and that VTE risk score can also be used to risk-stratify for 30-day medical and surgical complications as well as mortality.

PMID:
25958062
DOI:
10.1016/j.surg.2015.04.001
[Indexed for MEDLINE]

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