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• W4247318612 abstract "Background: It has been proposed that the risk of venous thromboembolism (VTE) may be reduced by preoperative administration of prophylactic unfractionated or low molecular-weight heparin in patients undergoing major abdominal surgery, with the notion that VTE risk begins intraoperatively. However, whether preoperative administration reduces incidence of VTE remains unknown, with practice patterns reflecting substantial variability among surgeons. We hypothesized that timing of heparin administration does not significantly alter the incidence of VTE in pancreatic surgery. Methods: An analysis was conducted using data from Massachusetts General Hospital’s National Surgical Quality Improvement Program from 2012 to 2017. All patients admitted for elective pancreatic resection were included and a manual chart search was conducted to confirm the administration of preoperative heparin. Patients with preoperative VTE’s were excluded. The primary outcome was development of VTE. Multivariate regression was performed, adjusting for patient demographics and various clinical factors. Results: In total, 1,448 patients were analyzed, of whom 1,062 received preoperative heparin (73.34%). Overall VTE rates were low, with 24 (1.66%) patients developing VTE. On unadjusted analysis, there was no statistically significant difference between patients who received preoperative pharmacologic prophylaxis compared with those who did not receive preoperative dosing (1.79% vs. 1.30%, respectively; p = 0.515). On adjusted analysis, there was still no difference between patients receiving preoperative heparin and no prophylaxis (OR 1.97, 95% CI 0.68-5.71; p = 0.214). There were a total of 38 (2.63%) bleeding events with no statistically significant difference between patients who received preoperative prophylaxis compared with those who did not receive preoperative dosing (2.30% vs. 3.64%, respectively; p = 0.148). Finally, there was an association between prolonged length of hospital stay (>11 days) and development of VTE (OR 4.26, 95% CI 1.22-14.86; p = 0.023) on multivariable analysis. No additional predictors were identified. Conclusion: Preoperative heparin administration did not significantly alter the incidence of VTE for patients who underwent elective pancreatic resections. Further exploration of this finding will lead to further refinement of established guidelines and standardization of perioperative care." @default.
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• W4247318612 date "2019-03-01" @default.
• W4247318612 modified "2023-10-02" @default.
• W4247318612 title "Does preoperative pharmacologic prophylaxis reduce the rate of venous thromboembolism in pancreatectomy patients?" @default.
• W4247318612 doi "https://doi.org/10.1016/j.hpb.2019.03.133" @default.
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