title: Defining incidence and risk factors of venous thromboemolism after hepatectomy.
abstract: BACKGROUND
  The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is poorly defined, leading to varied use of VTE prophylaxis among surgeons. We sought to define the incidence of VTE after liver surgery and identify risk factors associated with VTE.
  
  
  METHODS
  Incidence of VTE and associated risk factors within 90 days of hepatic resection between 2006 and 2012 at a major academic center was analyzed. Risk factors for VTE were identified using univariate and multivariate analyses.
  
  
  RESULTS
  A total of 599 patients were included in the study cohort; 30 (5.0 %) had a prior history of VTE. The indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; n = 402, 67.1 %) while 195 (32.6 %) patients underwent a major hepatectomy (≥3 Couinaud segments). Three hundred seven (51.3 %) patients were started on VTE chemoprophylaxis preoperatively with 407 (67.8 %) patients receiving VTE chemoprophylaxis within 24 h of surgery. Twenty-eight (4.7 %) patients developed VTE; 20 (3.3 %) had deep venous thrombosis (DVT), 11 (1.8 %) had pulmonary embolism (PE), and three (0.5 %) developed both DVT and PE. Among the VTE patients, 23 (82.1 %) had received VTE chemoprophylaxis. On multivariate analyses, history of VTE (odds ratio [OR] 4.51, 95 % confidence interval [CI] 1.81-17.22, P = 0.03), prolonged operative time (OR 1.17 per additional hour, 95 % CI 1.04-1.32, P = 0.009), and increased length of stay (LOS) (OR 1.07, 95 % CI 1.02-1.12, P = 0.01) were independent risk factors for VTE.
  
  
  CONCLUSIONS
  VTE within 90 days of hepatic resection is common, occurring in nearly one in 20 patients. Most VTE events occurred among patients who received current best practice prophylaxis for VTE. More aggressive strategies to identify and reduce the risk of VTE in patients at highest risk of VTE, including those with a history of VTE, extended operative time, and prolonged LOS, are warranted.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Aslam
authors: A
authors: Ejaz
authors: Gaya
authors: G
authors: Spolverato
authors: Yuhree
authors: Y
authors: Kim
authors: Donald L
authors: DL
authors: Lucas
authors: Brandyn
authors: B
authors: Lau
authors: Matthew
authors: M
authors: Weiss
authors: Fabian M
authors: FM
authors: Johnston
authors: Marin
authors: M
authors: Kheng
authors: Marian
authors: M
authors: Kheng
authors: Kenzo
authors: K
authors: Hirose
authors: Christopher L
authors: CL
authors: Wolfgang
authors: Elliott
authors: E
authors: Haut
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D005260:Female; D006400:Hematocrit; D006493:Heparin / Q000627:therapeutic use; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D048228:Intermittent Pneumatic Compression Devices; D007902:Length of Stay; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006493:Heparin