Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Creation and Validation of a Condition-Specific VTE Risk Assessment Tool for Open Ventral Hernia Repair Patients
Christopher J. Pannucci, MD MS1, Marten N. Basta, BA2, John P. Fischer, MD2, Stephen J. Kovach, MD2.
1University of Utah, Salt Lake City, UT, USA, 2University of Pennsylvania, Philadelphia, PA, USA.

Purpose:
Patients who require open ventral hernia repair (VHR) are at unknown risk of peri-operative venous thromboembolism (VTE) complications. Here, we utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to identify risk factors for 30-day VTE after open VHR and to create and validate a condition-specific risk assessment tool for open hernia repair patients.
Methods:
Eight years of ACS-NSQIP data were queried using Current Procedural Terminology code to identify patients with open hernia repair. The primary outcome of interest was 30-day VTE, including patients with deep venous thrombosis (DVT) or pulmonary embolus (PE). Regression-based analysis and subsequent bootstrap analysis allowed creation of a weighted, open VHR specific VTE risk assessment model. Risk factor weighting was performed based on beta coefficients. The newly created weighted RAM was then used to risk-stratify patients for both 30-day VTE risk and 30-day risk for other medical and surgical complications.
Results:
The ACS-NSQIP database contained 89,935 open hernia repair patients over the queried eight year period. 30-day rates for DVT, PE, and VTE were 0.68%, 0.49%, and 1.05%, respectively. Among patients with 30-day VTE, the average time to VTE was 10.7 days. A twelve factor, weighted risk assessment model was created using regression-based techniques and validated using bootstrapping (Figure 1). The weighted risk score allowed identification of a 22-fold variability (from 0.24% to 5.49%) in VTE risk among the overall open hernia repair population (Figure 2). Although created to risk-stratify for VTE, the risk score also showed excellent ability to risk-stratify for 30-day medical and surgical complications, inpatient length of stay, and 30-day mortality (Figure 3).
Conclusions:
30-day VTE risk after open hernia repair is 1.05%, but a large variability (22-fold) in VTE risk exists among the overall hernia population. Here, we have shown that a weighted VTE RAM can quantify VTE risk among the open hernia repair population. Additionally, the calculated VTE risk score can be used to risk-stratify for 30-day medical and surgical complications as well as mortality.



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