Venous Thromboembolism in High-Risk Patients: Are We Doing Enough for Prevention?

Abstract

Objectives: CEA in asymptomatic patients is recommended only when postoperative complications and mortality are kept low; but predicting CEA complications in a specific patient remains elusive. To better predict 30-day postoperative outcomes, we calculated a novel point-weight ordinal Frailty Risk Score (FRS) by an analysis of 20 preoperative risk factors based on their individual odds ratios (ORs) as predictors of postoperative complications using all vascular surgery cases in the 2005 to 2011 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (n 1⁄4 121,015). Methods: To compare the predictive value of this calculated FRS with that of patient demographics and surgical variables alone, we examined the predictive contribution value of five levels of FRS on four outcomes (stroke, myocardial infarction [MI], and mortality), and a composite of the three outcomes in all primary asymptomatic CEAs in the 2005 to 2011 ACSNSQIP database (n 1⁄4 39,859). Results: Thirty-day mortality occurred in 273 patients (0.7%), stroke in 527 (1.3%), MI in 301 (0.8%), and the composite outcome was positive in 1008 (2.5%). We found that by itself, the FRS level was strongly and significantly associated with all four outcomes (Table). For stroke, we used only three levels of frailty because the stroke rate no longer increased after this point, and found that for the lowest vs highest frailty levels, the rate of stroke was 1.1% vs 2.4% (P < .0001). Percentage of patients that were positive for the composite outcome was 1.7% in lowest vs 15.2% in the highest FRS group (P < .0001). Conclusions: An easy-to-calculate FRS can help stratify risk based on preoperative patient characteristics and will help to identify asymptomatic patients for whom CEA is risky.