title: Balancing venous thromboembolism and hematoma after breast surgery.
abstract: OBJECTIVE
  The purposes of this study are (1) to determine our institution's rate of venous thromboembolic events (VTE) and hematomas following breast surgery, and (2) to compare our breast surgery VTE rate with both our general surgery population and the National surgical quality improvement program (NSQIP) dataset.
  
  
  METHODS
  Prospectively collected NSQIP data from April 2006 to June 2010 were analyzed. Our institution's VTE rates, pharmacologic prophylaxis (PCP) utilization, and hematomas were reviewed for patients undergoing breast surgery. The VTE rate was compared with NSQIP patient populations.
  
  
  RESULTS
  Among 4,579 breast operations at our institution over this time period, 988 (21.6 %) were analyzed through NSQIP. The VTE rate following breast operations was 4/988 (0.4 %): 0/236 for those with benign disease and 4/752 (0.5 %) for those with breast cancer (p = 0.58). PCP was received by 147/752 (19.5 %) cancer patients. In cancer patients, the hematoma rate requiring reoperation was 3/147 (2.0 %) in those receiving PCP and 12/605 (2.0 %) in those not receiving PCP (p = 1.0). Breast surgery patients had a similar VTE rate compared with the institutional general surgery population (0.7 %, p = 0.254) and versus national general surgery patients from NSQIP (0.7 %, p = 0.29). Our institution's VTE incidence for patients with breast cancer undergoing mastectomy was significantly higher than "like" NSQIP centers.
  
  
  CONCLUSIONS
  Our breast surgery VTE rate was similar to our general surgery population. Our mastectomy population had a higher VTE incidence compared with other NSQIP sites. Patients undergoing mastectomy, especially if combined with axillary lymph node dissection or reconstruction, should be considered for routine PCP.
authors: Hospital Pharmacy Services, Mayo Clinic, Rochester, MN, USA.
authors: Jenna K
authors: JK
authors: Lovely
authors: Sharon A
authors: SA
authors: Nehring
authors: Judy C
authors: JC
authors: Boughey
authors: Amy C
authors: AC
authors: Degnim
authors: Rajakumar
authors: R
authors: Donthi
authors: William Scott
authors: WS
authors: Harmsen
authors: James W
authors: JW
authors: Jakub
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D058996:Quality Improvement; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000925:Anticoagulants