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Background The incidence of venous thromboembolism (VTE) among patients undergoing hepatic

Background The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is usually poorly defined leading to varied use of VTE prophylaxis among surgeons. indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; =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 DVTand 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 =0.03) prolonged operative time (OR 1.17 per additional hour 95 % CI 1.04-1.32 =0.009) and increased length of stay (LOS) (OR 1.07 95 % CI 1.02-1.12 =0.01) were indie risk factors for VTE. Conclusion VTE GSK1838705A within 90 days of hepatic resection is usually 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. <0.20). For statistical analyses values less than 0.05 (two-tailed) were deemed significant. Odds ratios (OR) were presented with 95 % confidence intervals (CI). All analyses were carried out with STATA version 12.0 (StataCorp LP College Station TX GSK1838705A USA). Results Patient and Surgical Details The study cohort consisted of 599 patients who underwent a planned hepatectomy. The median individual age was 58 years (interquartile range [IQR] 49 Males (49.6 %) and females (50.4 %) were evenly distributed in the cohort. The majority of patients (=489 81.6 %) were non-Hispanic white. Most patients (=441 74.1 %) were classified as ASA 3 with an ECOG overall performance GSK1838705A status of 0 (=544 90.8 %) while a subset had benign disease (=55 9.2 %). The most common indications for surgery were colorectal liver metastasis (=243 47.7 %) non-colorectal liver metastasis (=136 26.7 %) main liver malignancy (=120 23.6 %) or benign hepatic lesion (=55 9.2 %). The majority of patients had not received any previous liver-directed therapy (=419 70 %70 %); GSK1838705A about one-quarter of patients (=128 21.4 %) had received preoperative systemic chemotherapy. Of notice patients with malignancy as an indication for surgery were more likely to have had a prior history of VTE (OR 5.24 CI 1.41-19.17 = 402 67.1 %) 195 (32.6 %) patients underwent a major hepatectomy (three or more GSK1838705A Couinaud segments) and two patients (<1 %) underwent ablation only (Table 2). Of those who underwent a minor hepatectomy 155 (38.6 GSK1838705A %) had a non-anatomic hepatic wedge resection with the remaining undergoing a single or bi-segmentectomy (=247 61.4 %). Of those who underwent a major hepatectomy 135 (69.2 %) had a hemi-hepatectomy and 60 (31.8 %) had an extended hemi-hepatectomy. Overall median operative time was 4.6 h (IQR 3.5-6.2) and median estimated blood loss was 500 ml (IQR 250-900). Table Rabbit polyclonal to CDKN2A. 2 Operative and post-operative characteristics of patients undergoing planned hepatectomy VTE Prophylaxis Type and Administration Nearly all patients (=592 98.8 %) received either mechanical and/or chemoprophylaxis during their hospitalization. The majority of patients received chemoprophylaxis (= 450 75.1 %) while 142 (23.7 %) patients received only mechanical prophylaxis (i.e. sequential compression devices); seven (1.2 %) patients did not receive any type of VTE prophylaxis. Among the subset of patients receiving chemoprophylaxis 307 (68.2 %) patients were started on chemoprophylaxis in the preoperative setting prior to surgical incision and 406 (90.2 %) patients received chemoprophylaxis within 24 h post-operatively. The mind-boggling majority of patients received subcutaneous heparin either every 8 h (= 328 54.8 %) or 12 h (=111.