Extended-duration thromboprophylaxis after ventral hernia repair: a risk model to predict venous thrombotic events after hospital discharge

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 26; no. 3; pp. 919 - 926
• Main Authors: Kumar, S. B., Mettupalli, D., Carter, J. T.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01.06.2022; Springer Nature B.V
• Subjects: Abdominal Surgery; Aftercare; Aged; Anticoagulants; Body mass index; Hernia; Hernia, Ventral - etiology; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Hospitals; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Original; Original Article; Patient Discharge; Patients; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Postoperative Complications - surgery; Prediction models; Quality control; Risk Factors; Surgery; Thromboembolism; Venous Thromboembolism - etiology; Venous Thromboembolism - prevention & control; Risk prediction; Ventral hernia repair; Thromboprophylaxis; Venous thromboembolism
• ISSN: 1265-4906; 1248-9204
• DOI: 10.1007/s10029-021-02481-x

Background Venous thromboembolism (VTE) is a major source of morbidity and mortality after ventral hernia surgery, but the risk of VTE after discharge has not been reported. Study design Data from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) were used to investigate the risk of post-discharge VTE. Current procedural terminology (CPT) codes identified all reported patients who underwent ventral hernia repair from 2011 to 2017. We created a multivariable regression model for post-discharge VTE, using the 2011–2016 dataset to develop the model and 2017 as a validation set. The prediction model was used to create a risk calculator as a mobile application. Results The rate of VTE after surgery was 0.62% (878 of 141,065) with 48% occurring after discharge from the hospital. The final predictor model consisted of eight variables: age > 60 years, male sex, body mass index (BMI) ≥ 35 kg/m 2 ), operative time > 2 h, concurrent panniculectomy, post-operative hospitalization > 1 day, presence of bleeding disorder, and emergency operation. The model had good calibration and discrimination (Hosmer–Lemeshow goodness-of-fit test, p  = 0.71; c -statistic = 0.71). Threshold analysis showed a strategy of extended-duration thromboprophylaxis was optimized when the risk of post-discharge VTE was > 0.3%. Conclusion Forty-eight percent of VTEs after ventral hernia repair occur after discharge, particularly in older, male, obese patients undergoing longer and complex operations that require hospitalization > 1 day. Post-discharge thromboprophylaxis should be considered in these patients, particularly when risk of VTE exceeds 0.3%.