title: Who Should Get Extended Thromboprophylaxis After Bariatric Surgery?: A Risk Assessment Tool to Guide Indications for Post-discharge Pharmacoprophylaxis.
abstract: To determine the risk factors for 30-day postdischarge venous thromboembolism (VTE) after bariatric surgery and to identify potential indications for extended pharmacoprophylaxis.
  
  
  
  VTE is among most common causes of death after bariatric surgery. Most VTEs occur after hospital stay; still a few patients receive extended pharmacoprophylaxis postdischarge.
  
  
  
  From American College of Surgeons-National Surgical Quality Improvement Program, we identified 91,963 patients, who underwent elective primary and revisional bariatric surgery between 2007 and 2012. Regression-based techniques were used to create a risk assessment tool to predict risk of postdischarge VTE. The model was validated using the 2013 American College of Surgeons-National Surgical Quality Improvement Program dataset (N = 20,575). Significant risk factors were used to create a user-friendly online risk calculator.
  
  
  
  The overall 30-day incidence of postdischarge VTE was 0.29% (N = 269). In those experiencing a postdischarge VTE, mortality increased about 28-fold (2.60% vs 0.09%; P < 0.001). Among 45 examined variables, the final risk-assessment model contained 10 categorical variables including congestive heart failure, paraplegia, reoperation, dyspnea at rest, nongastric band surgery, age ≥60 years, male sex, BMI ≥50 kg/m, postoperative hospital stay ≥3 days, and operative time ≥3 hours. The model demonstrated good calibration (Hosmer-Lemeshow goodness-of-fit test, P = 0.71) and discrimination (c-statistic = 0.74). Nearly 2.5% of patients had a predicted postdischarge VTE risk >1%.
  
  
  
  More than 80% of post-bariatric surgery VTE events occurred post-discharge. Congestive heart failure, paraplegia, dyspnea at rest, and reoperation are associated with the highest risk of post-discharge VTE. Routine post-discharge pharmacoprophylaxis can be considered for high-risk patients (ie, VTE risk >0.4%).
authors.affiliation: *Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH †Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.forename: Amin
authors.initials: A
authors.lastname: Andalib
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.forename: Derrick
authors.initials: D
authors.lastname: Cetin
authors.forename: Bartolome
authors.initials: B
authors.lastname: Burguera
authors.forename: John
authors.initials: J
authors.lastname: Bartholomew
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery; D000066491:Clinical Decision-Making / Q000379:methods*; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents