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American Association for Hand Surgery

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Venous Thromboembolism Following Hand and Upper Extremity Surgery: A Population-Based Assessment of Incidence and Risk Factors Using the Healthcare Cost and Utilization Project Databases
Wen Xu, MD, Arturo J. Rios-Diaz, MD, Jesse Hsu, PhD, Robyn B. Broach, PhD and Ines C. Lin, MD, University of Pennsylvania, Philadelphia, PA

Background
While venous thromboembolism (VTE) is a serious, potentially life-threatening perioperative complication associated with major surgical procedures, its incidence in patients undergoing upper extremity surgery is not well described. We hypothesize that patients who undergo outpatient upper extremity surgery are still at risk of VTE even after 30 days of their procedure.
Methods
Patients undergoing outpatient upper extremity surgery were identified within six State Ambulatory Surgery and Services Databases and followed-up for 180 days within State Emergency Department Databases and State Inpatient Databases (2007-2016). The primary outcome was VTE, defined as deep vein thrombosis (DVT) and/or pulmonary embolism (PE), within 180 days of surgery. Descriptive statistics were used to summarize patient demographic, clinical and procedural characteristics. Multivariable cox regression was used to identify factors associated with 180-day VTE.
Results
The final sample included 1,355,607 patients. On average, patients were age 51.7 years (SD 19.5 years) with the majority being female (54.3%) and White (74.6%). The most common procedures involved nerves (35.3%), tendons and ligaments (28.6%), and fractures/dislocations (21.9%). The post-operative VTE rate was 0.03% within 30 days and 0.14% within 180 days of upper extremity surgery. The DVT rate was 0.10% and PE rate was 0.06%. The majority of DVTs (85%) occurred in the lower extremity. VTE rates within 180 days differed amongst common procedures, including: treatment of fractures/dislocations (0.13%), carpal tunnel release (0.16%), cubital tunnel release (0.20%), DeQuervain release (0.09%), Dupuytrens fasciotomy/fasciectomy (0.14%), ganglion excision (0.08%), and trigger finger release (0.13%) (p<0.001). The average time from index procedure to post-operative VTE was 84.5 days. A Cox regression model found that specific demographics (older age, Black race, public insurance, non-routine discharge), comorbidities (history of bleeding or clotting disorders, former or current tobacco use, cancer, hypertension, paralysis, heart failure, obesity), and postoperative complications (bleeding, acute kidney injury, dehiscence, thrombophlebitis, acute cerebrovascular disease, pneumonia, and urinary tract infection) were significantly associated with 180-day VTE.
Conclusion
VTE after outpatient upper extremity surgery is uncommon, with an overall incidence of 0.14% within 180 days of surgery. Risk factors for VTE after upper extremity surgery include specific demographics, preoperative comorbidities, and postoperative complications.


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