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 RR30. Prediction of Post-discharge Venous Thromboembolism: A Risk Assessment Model to Guide Decision Making in Post-discharge Thromboprophylaxis

​James C. Iannuzzi, Kate C. Young, Michael J. Kim, John R. Monson, Fergal J. Fleming
University of Rochester, Rochester, NY.

OBJECTIVES: The risk of a post-discharge venothromboembolism (either deep vein or pulmonary embolism) (VTE) is increasingly recognized yet the prescription of post-discharge thromboprophylaxis is inconsistent. There is a paucity of information to aid clinicians in identifying surgical patients who are at increased risk of post-discharge VTE. This study aimed to determine the incidence and risk factors associated with symptomatic post-discharge VTE and to develop a risk score to identify those patients who may benefit from extended prophylaxis.

METHODS: All non-orthopedic cases in which the patient was discharged alive, without inpatient VTE were selected from the 2005-2009 NSQIP database. Multivariate logistic regression was used to create and validate a point score system to predict post-discharge VTE.

RESULTS: The incidence of predicted post-discharge VTE ranged from 0%-2.94%. Race, increasing age, steroid use, BMI ≥ 30, malignancy, higher ASA class, increasing operative time, length of post-surgical stay, and major postoperative complication were all associated with increased risk of post-discharge VTE. The dataset had a good predictive property ) c-statistic ≥ 0.7). The post-discharge VTE score can identify a high-risk cohort with a probability for VTE ranging from 1% to 2.94%.

CONCLUSIONS: This novel post-discharge VTE prediction score utilizes patient, operative and early outcome factors to accurately identify patients at increased risk of post-discharge thromboembolic event. The development of a patient specific post-discharge VTE risk profile may help address the challenge of determining post-discharge prophylaxis requirements.

AUTHOR DISCLOSURES: F. J. Fleming, Nothing to disclose; J. C. Iannuzzi, Nothing to disclose; M. J. Kim, Nothing to disclose; J. R. Monson, Nothing to disclose; K. C. Young, Nothing to disclose.

Posted April 2012

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