Background
The fear of an early post‐pancreatectomy haemorrhage (PPH) may prevent surgeons from prescribing post‐operative venous thromboembolism (VTE) chemoprophylaxis. The primary hypothesis of this study was that the national post‐pancreatectomy early PPH rate was lower than the rate of VTE. The secondary hypothesis was that patients at high risk for post‐discharge VTE could be identified, potentially facilitating the selective use of extended chemoprophylaxis.
Patients and methods
All elective pancreatectomies were identified in the 2005 to 2010 American College of Surgeons‐National Surgical Quality Improvement Program (ACS‐NSQIP) database. Factors associated with 30‐day rates of (pre‐ versus post‐discharge) VTE, early PPH (transfusions > 4 units within 72 h) and return to the operating room (ROR) with PPH were analysed.
Results
Pancreaticoduodenectomies (PD) and distal pancreatectomies (DP) numbered 9140 (66.4%) and 4631 (33.6%) out of 13 771 pancreatectomies, respectively. Event rates included: VTE (3.1%), PPH (1.1%) and ROR+PPH (0.7%). PD and DP had similar VTE rates (P > 0.05) with 31.9% of VTE occurring post‐discharge. Independent risk factors for late VTE included obesity [odds ratio (OR), 1.5], age ≥ 75 years (OR, 1.8), DP (OR, 2.4) and organ space infection (OR, 2.1) (all P < 0.02).
Conclusions
Within current practice patterns, post‐pancreatectomy VTE outnumber early haemorrhagic complications, which are rare. The fear of PPH should not prevent routine and timely post‐pancreatectomy VTE chemoprophylaxis. Because one‐third of VTE occur post‐discharge, high‐risk patients may benefit from post‐discharge chemoprophylaxis.