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Original Research: Pulmonary Vascular Disease |

A Validated Risk Model to Predict 90-Day VTE Events in Postsurgical PatientsValidated VTE Risk Model for Surgical Patients

Christopher J. Pannucci, MD; Sandra Laird, MHA, RN; Justin B. Dimick, MD; Darrell A. Campbell, MD; Peter K. Henke, MD
Author and Funding Information

From the Section of Plastic Surgery (Dr Pannucci), the Division of Minimally Invasive Surgery (Dr Dimick), and the Section of Vascular Surgery (Dr Henke), University of Michigan Hospitals (Dr Campbell); and Michigan Surgical Quality Collaborative (Ms Laird), Ann Arbor, MI.

Correspondence to: Peter K. Henke, MD, Section of Vascular Surgery, Cardiovascular Center, Room 5463, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5867; e-mail: henke@med.umich.edu


A portion of these data were presented at the American Venous Forum 2013 Annual Meeting, February 27-March 3, 2013, Phoenix, AZ.

Funding/Support: This project was supported by the Michigan Institute for Clinical and Health Research [Grant UL1RR024936] and by Sanofi SA.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):567-573. doi:10.1378/chest.13-1553
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Background:  VTE is the proximate cause of 100,000 deaths in the United States each year. Perioperative VTE risk among surgical patients varies by 20-fold, which highlights the importance of risk stratification to identify high-risk patients, in whom chemoprophylaxis can decrease VTE risk, and low-risk patients, for whom the risk-benefit relationship of prophylaxis may be unfavorable.

Methods:  We used data from a statewide surgical quality collaborative for surgical procedures performed between 2010 and 2012. Regression-based techniques identified predictors of 90-day VTE while adjusting for procedural complexity and comorbid conditions. A weighted risk index was created and was validated subsequently in a separate, independent dataset.

Results:  Data were available for 10,344 patients, who were allocated randomly to a derivation or validation cohort. The 90-day VTE rate was 1.4%; 66.2% of the derivation cohort and 65.5% of the validation cohort received chemoprophylaxis. Seven risk factors were incorporated into a weighted risk index: personal history of VTE, current cancer, sepsis/septic shock/systemic inflammatory response syndrome, age ≥ 60 years, BMI ≥ 40 kg/m2, male sex, and family history of VTE. Prediction for 90-day VTE was similar in the derivation and validation cohorts (areas under the receiver operator curve, 0.72 and 0.70, respectively). An 18-fold variation in 90-day VTE rate was identified.

Conclusions:  A weighted risk index quantifies 90-day VTE risk among surgical patients and identifies an 18-fold variation in VTE risk among the overall surgical population.

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