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New Risk Assessment Tool For Venous Thromboembolism in Plastic Surgery Patients: Analysis of National Surgical Quality Improvement Program Dataset
Alexey Markelov MD, Jeffrey Borrebach MS, Douglas Mcgill MS, Vu Nguyen MD
University of Pittsburgh Medical Center
2014-02-28
Presenter: Alexey Markelov
Affidavit:
This study was performed by the resident with guidance from senior faculty member
Director Name: Joseph Losee
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose:
Deep vein thrombosis and pulmonary embolism, the common clinical manifestations of venous thromboembolism (VTE), are among the most common preventable complications in patients undergoing plastic surgery procedures. Because VTE prophylaxis often remains suboptimal despite long-standing evidence-based recommendations, it would be useful to identify high-risk patients ahead of time to deliver targeted prophylaxis.
Methods:
We conducted a retrospective analysis of the 2006-2012 NSQIP database containing 55 CPT codes representing the most commonly performed plastic surgery procedures. The most significant risk factors associated with VTE were determined and a multiple logistic regression model was constructed for each group.
Results:
Results: 35,521 patients who underwent plastic surgery procedures were included in the analysis. Rate of VTE event in the entire group was 0.55% (195 cases). The highest incidence of VTE was observed in general reconstructive procedures group (1.7%) and the lowest incidence was found among the breast procedures (0.29%). After analyzing 136 variables included in NSQIP database we identified only four, which were strongly associated with VTE events. The main predictors of thromboembolic events in these groups were: age of the patient, body mass index, operation time and history of sepsis during same admission (p value < 0.05). 57.8% of VTEs occurred post-discharge, and of those, 41.4% occurred within one week.
Conclusion:
Using NSQIP derived data, we created statistical models that can serve as a reliable and clinically applicable tool for identification of high-risk plastic surgery patients, who might require extended VTE prophylaxis after hospitalization.
