What is the clinical evidence from this study?

Study design: Cohort. Population: General surgery (n=159039). Intervention: Post-discharge venous thromboembolism (VTE) vs. No VTE. Primary outcome: 90-day mortality (OR 4.03, 95% CI 2.95-5.51, p=<0.001).

What question did this study set out to answer?

To quantify 90-day in-hospital and post-discharge venous thromboembolism (VTE) risk and associated mortality across general surgical procedures using linked hospital and primary care data.

December 29, 2015PLoS ONEOpen Access

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England

Q: What are the key findings of this study?

Post-discharge venous thromboembolism accounted for 64.8% of all postoperative VTE events and independently predicted 90-day mortality (OR 4.03) in patients undergoing general surgery.

Q: What question did this study set out to answer?

To quantify 90-day in-hospital and post-discharge venous thromboembolism (VTE) risk and associated mortality across general surgical procedures using linked hospital and primary care data.

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Key result

Post-discharge venous thromboembolism accounted for 64.8% of all postoperative VTE events and independently predicted 90-day mortality (OR 4.03) in patients undergoing general surgery.

Why the study?

What is the risk of post-discharge VTE and its association with mortality in adults undergoing general surgery?

Key Points

To quantify 90-day in-hospital and post-discharge venous thromboembolism (VTE) risk and associated mortality across general surgical procedures using linked hospital and primary care data.
Longitudinal cohort study linking CPRD (primary care), HES (hospital admissions), ONS (death registry), and cancer network data across England between April 1, 1997, and March 31, 2012.
Included 168,005 adult general surgical procedures across 12 operation categories to assess 90-day in-hospital VTE, 90-day post-discharge VTE, and 90-day mortality.
Calculated multivariable odds ratios adjusting for procedural category, cancer stage, surgical urgency, and demographic covariates.
There were 981 VTE events captured within 90 days (23.7 per 1,000 patient-years), with post-discharge cases accounting for 64.8% (636/981) of all recorded events.
Linking primary care records increased postoperative VTE detection by a factor of 1.38 compared with hospital and death registry data alone.
Post-discharge VTE independently predicted 90-day mortality (OR = 4.03, 95% CI 2.95–5.51, p < 0.001), while in-hospital VTE also increased mortality (OR = 2.07, 95% CI 1.51–2.85, p < 0.001).

Study Design

Type

Cohort (n=159,039)

Multicenter

Yes

Structured PICO

What is the risk of post-discharge VTE and its association with mortality in adults undergoing general surgery?

Population

159,039 adults undergoing general surgical procedures in England, followed for 90 days to assess the incidence of postoperative venous thromboembolism and its association with mortality.

Exposure

General surgery

Outcome

90-day in-hospital VTE, 90-day post-discharge VTE, and 90-day mortalityhard clinical

Main Result

Odds Ratio: 4.03 (95% CI 2.95–5.51)

p-value: p=<0.001

A large proportion of postoperative VTE occurs after hospital discharge and is strongly associated with increased 90-day mortality, highlighting the value of linked primary care data for accurate risk assessment.

Limitations

Capture of VTE presenting to healthcare only, potentially undercounting events.
Lack of information on adherence to pharmacological thromboprophylaxis due to no data linkage to hospital pharmacy records.
No 'present on arrival' flag on Hospital Episodes Statistics (HES) data.
Capture of VTE presenting to healthcare only
Lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records

Discussion

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Implication

Post-discharge VTE monitoring may aid risk stratification after general surgery; leaves open whether extended prophylaxis reduces mortality in prospective trials.

Cite This Study

Bouras et al. (2015) conducted a cohort in General surgery (n=159,039). Post-discharge venous thromboembolism (VTE) vs. No VTE was evaluated on 90-day mortality (OR 4.03, 95% CI 2.95-5.51, p=<0.001). Post-discharge venous thromboembolism accounted for 64.8% of all postoperative VTE events and independently predicted 90-day mortality (OR 4.03) in patients undergoing general surgery.

synapsesocial.com/papers/6a1f51bbd09bc027e48350ba https://doi.org/10.1371/journal.pone.0145759

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Implication

Post-discharge VTE monitoring may aid risk stratification after general surgery; leaves open whether extended prophylaxis reduces mortality in prospective trials.

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider