J Surg Res. 2013 Jan 2. pii: S0022-4804(12)01960-9. doi: 10.1016/j.jss.2012.12.016. [Epub ahead of print]Nomograms to predict risk of in-hospital and post-discharge venous thromboembolism after abdominal and thoracic surgery: an American College of Surgeons National Surgical Quality Improvement Program analysis.Shah DR, Wang H, Bold RJ, Yang X, Martinez SR, Yang AD, Khatri VP, Wisner DH, Canter RJ.SourceDivision of Surgical Oncology, Department of Surgery, University of California Davis Comprehensive Cancer Center, Sacramento, California.AbstractBACKGROUND:Postoperative venous thromboembolism (VTE) is increasingly viewed as a quality of care metric, although risk-adjusted incident rates of postoperative VTE and VTE after hospital discharge (VTEDC) are not available. We sought to characterize the predictors of VTE and VTEDC to develop nomograms to estimate individual risk of VTE and VTEDC.METHODS:Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 471,867 patients who underwent inpatient abdominal or thoracic operations between 2005 and 2010. We excluded primary vascular and spine operations. We built logistic regression models using stepwise model selection and constructed nomograms for VTE and VTEDC with statistically significant covariates.RESULTS:The overall, unadjusted, 30-d incidence of VTE and VTEDC was 1.5% and 0.5%, respectively. Annual incidence rates remained unchanged over the study period. On multivariate analysis, age, body mass index, presence of preoperative infection, operation for cancer, procedure type (spleen highest), multivisceral resection, and non-bariatric laparoscopic surgery were significant predictors for VTE and VTEDC. Other significant predictors for VTE, but not VTEDC, included a history of chronic obstructive pulmonary disease, disseminated cancer, and emergent operation. We constructed and validated nomograms by bootstrapping. The concordance indices for VTE and VTEDC were 0.77 and 0.67, respectively.CONCLUSIONS:Substantial variation exists in the incidence of VTE and VTEDC, depending on patient and procedural factors. We constructed nomograms to predict individual risk of 30-d VTE and VTEDC. These may allow more targeted quality improvement interventions to reduce VTE and VTEDC in high-risk general and thoracic surgery patients.Copyright 2013 Elsevier Inc. All rights reserved.Uma nova pesquisa da UC Davis Comprehensive Cancer Center, publicado no Journal of Surgical Research, pode ajudar os medicos a determinar quais pacientes estao sob maior risco de coagulos sanguineos pos-cirurgicos, nas pernas ou nos pulmoes.Uma equipe, liderada por Robert Canter, professor associado de cirurgia da UC Davis, estudou o historico medico de mais de 470.000 pacientes cirurgicos para determinar quais os fatores que aumentaram o risco de coagulos de sangue, tambem chamado de tromboembolismo venoso (TEV). O equipe criou, entao, um nomograma, um tipo de calculadora que pode auxiliar os medicos a predizer o risco de 30 dias para um TEV, de um individuo. Os resultados podem modificar a pratica clinica por meio de uma abordagem mais racional para prevenir coagulos sanguineos perigosos.Coagulos de sangue sao um desafio critico para a seguranca e a qualidade nos hospitais em todo o pais. Enquanto estes coagulos podem ser evitados pela administracao de anticoagulantes, como a heparina, tais medidas aumentam o risco de hemorragia. Para complicar a situacao, os medicos nao tem obtido uma maneira para determinar quais pacientes estao sob maior risco de coagulos de sangue, forcando-os a adotar o plano de uma unica maneira