1
|
Edwards MA, Falstin M, Uddandam A, Brennan E, Spaulding A. Caprini guideline indicated venous thromboembolism (VTE) prophylaxis among inpatient surgical patients: are there racial/ethnic differences in practice patterns and outcomes? Am J Surg 2024:115785. [PMID: 38849278 DOI: 10.1016/j.amjsurg.2024.115785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 03/04/2024] [Accepted: 05/27/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND While racial disparity in surgical mortality due to venous thromboembolism (VTE) has improved, a gap persists. Our study aim was to determine differences in VTE prevention practices and their impact on outcomes among racial surgical cohorts. METHODS Elective surgeries performed between 1.1.2016 and 5.31.2021 were included. Racial/ethnic cohorts were propensity-matched 1:1 to non-Hispanic White (NHW) patients, and outcomes were compared using unadjusted logistic regression. Match cohort balance was assessed using absolute standardized mean differences and linear model analysis of variance (ANOVA). Pearson's Chi-square tests evaluated bi-variate associations. Conditional logistic regression to compare outcomes between matched groups. Odds ratios, 95 % confidence intervals, and p-values are reported. Analyses were performed using R version 4.1.2 and the R package Matchit. RESULTS Non-Hispanic other race (NHOR) (vs. NHW) patients were less likely to receive inpatient prophylaxis (OR 0.86, CI:0.76-0.98). Appropriate prophylaxis resulted in similar VTE for NHB (p = 0.71) and Hispanic (p = 0.06), compared to NHW patients. Inpatient bleeding was higher in Hispanic patients with a higher likelihood of receiving appropriate prophylaxis (OR 1.94, CI:1.16-3.32) and NHOR patients with a lower likelihood (OR 1.90, CI:1.10-3.36) CONCLUSION: Postoperative VTE was similar for minority patients receiving appropriate prophylaxis, compared to NHW patients. Inpatient bleeding was more likely in Hispanic and NHOR patients but may not be related to receiving appropriate prophylaxis. NHOR patients were less likely to receive inpatient thromboprophylaxis.
Collapse
Affiliation(s)
- Michael A Edwards
- Mayo Clinic, Department of Surgery, Division of Advanced GI and Bariatric Surgery, Jacksonville, FL, 32224, USA.
| | - Mark Falstin
- Mayo Clinic, Department of Surgery, Division of Advanced GI and Bariatric Surgery, Jacksonville, FL, 32224, USA
| | - Akash Uddandam
- McMaster University, Department of Health Sciences, Hamilton, Ontario, L8S 4L8, Canada
| | - Emily Brennan
- Mayo Clinic, Robert D. and Patricia E. Kern Center, Division of Health Care Delivery Research, Jacksonville, FL, 32224, USA
| | - Aaron Spaulding
- Mayo Clinic, Robert D. and Patricia E. Kern Center, Division of Health Care Delivery Research, Jacksonville, FL, 32224, USA
| |
Collapse
|
2
|
Azawi NH, Tolouee S, Dabestani S. Incidence and associated risk factors of venous thromboembolism after open and laparoscopic partial nephrectomy in patients administered short-period thromboprophylaxis: a Danish nationwide population-based cohort study. Scand J Urol 2023; 57:81-85. [PMID: 36703546 DOI: 10.1080/21681805.2023.2171112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To report the risk of venous thromboembolism (VTE) after partial nephrectomy in Denmark. MATERIALS AND METHODS A nationwide population-based registry was used to conduct a retrospective cohort study. All partial nephrectomies from January 2010 to August 2018 were assessed for postoperative VTE events. Univariable and multivariable analyses were used to evaluate the odds of postoperative VTE within 4 weeks and 4 months after partial nephrectomy in patients who received standard-of-care thromboprophylaxis. RESULTS Among 2355 patients, postoperative VTE risk was 0.6% and 0.9%, at 4 weeks and 4 months, respectively. In multivariate analysis, prior VTE (OR = 24.9, p < 0.001) and length of hospital stay (OR = 0.89, p < 0.001) were predictors of postoperative VTE within 4 months after partial nephrectomy. Limitations included the retrospective and registry-based study design and the absence of BMI data. CONCLUSION Incidence of postoperative VTE is rare, but patients with prior VTE and those with a greater length of hospital stay are at greater long-term risk and should be evaluated when considering thromboprophylaxis.
Collapse
Affiliation(s)
- Nessn H Azawi
- Department of Urology, Zealand University Hospital, Roskilde, Denmark.,Institute of Clinical Medicine, Copenhagen University, Denmark
| | - Sara Tolouee
- Department of Urology, Zealand University Hospital, Roskilde, Denmark
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Sweden
| |
Collapse
|
3
|
Cueto-Robledo G, Navarro-Vergara DI, Roldan-Valadez E, Garcia-Cesar M, Graniel-Palafox LE, Cueto-Romero HD, Perez-Calatayud AA, Enriquez-Garcia R, Casillas-Suarez C. Pulmonary embolism (PE) prevalence in Mexican-mestizo patients with severe SARS-COV-2 (COVID-19) pneumonia at a tertiary-level hospital: A review. Curr Probl Cardiol 2022:101208. [PMID: 35460689 PMCID: PMC9020648 DOI: 10.1016/j.cpcardiol.2022.101208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/13/2022] [Indexed: 02/08/2023]
Abstract
Since the report of the first case of COVID-19 in Wuhan, China, on December 31, 2019, several associated thrombotic complications have been reported, mainly venous thromboembolic events, and myocardial infarctions, in addition to peripheral arterial thrombosis and cerebral vascular events, which have been attributed to a hypercoagulable state. We aimed to know the prevalence and prognostic biomarkers in patients with pulmonary thromboembolism (PE) and SARS Cov-2 pneumonia. Hospitalized patients with SARS Cov-2 pneumonia who have had clinical, biomarker, and imaging data (chest angiography) of pulmonary thromboembolism were included. Descriptive statistics and prevalence rates were calculated. For the analysis between the groups, the paired Student's t and the Wilcoxon test were performed. CT angiography was performed on 26 patients at our institution, with a diagnosis of severe pneumonia secondary to SARS-CoV2. 9 of the patients (34.6%) had a venous thromboembolic disease. Type 2 DM was the most frequent comorbidity up to 55.5% of the total; it was followed by obesity and overweight in 55.5%, and in third place, by systemic arterial hypertension in 33.3% of the cases, 1 (11.1%) patient had chronic kidney disease and 1 (11.1%) patient with a history of cancer, only 1 patient met criteria and was treated with thrombolysis. 6 (66.6%) of the patients had segmental PE, 3 (33.3%) patients had subsegmental PE, and 4 (44.4%) patients presented pulmonary infarction.
Collapse
Affiliation(s)
- Guillermo Cueto-Robledo
- Pulmonary Circulation Clinic, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico; Cardiorespiratory Emergencies, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico. Mexico City, Mexico.
| | | | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia.
| | - Marisol Garcia-Cesar
- Pulmonary Circulation Clinic, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico.
| | | | - Hector-Daniel Cueto-Romero
- Cardiorespiratory Emergencies, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico.
| | | | - Rocio Enriquez-Garcia
- Department of Radiology, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico.
| | - Catalina Casillas-Suarez
- Pneumology Department, Hospital General de Mexico "Dr. Eduardo Liceaga", 06720, Mexico City, Mexico.
| |
Collapse
|