Routine venous thromboembolism screening after pneumonectomy: The more you look, the more you see.
OBJECTIVES
Symptomatic venous thromboembolism (VTE) after pneumonectomy is associated with poor prognosis. We describe a new care pathway for patients undergoing pneumonectomy in which asymptomatic lower-extremity VTE screening was performed to determine if it increases VTE detection and potentially decreases sequelae.


METHODS
112 patients underwent pneumonectomy from 2006 to 2013 at Cleveland Clinic and were enrolled in a care pathway that included VTE prophylaxis and routine, predischarge, lower-extremity VTE screening. These data were contrasted with a previously published cohort of 336 patients (1990-2001) who underwent pneumonectomy without routine VTE screening.


RESULTS
10 of 112 patients (8.9%) had VTE detected by screening before discharge. An additional 4 patients (3.6%) with a negative predischarge screen developed symptomatic VTE within 30 days. Six patients (5.4%) developed VTE after pneumonectomy beyond the first 30 days. Prevalence of in-hospital VTE in the screened cohort was significantly higher than that of the non-screened cohort (3.0%; P = .008). Similarly, VTE within 30 days in the screened cohort (13%) was significantly higher than in the nonscreened cohort (5.0%; P = .007). In both cohorts, a peak was observed approximately 6 days after pneumonectomy and plateaued after 30 days. The presence of a VTE portended worse long-term survival: 66% at 1 year versus 85% for those not developing a VTE.


CONCLUSIONS
Prevalence of VTE after pneumonectomy is higher than previously thought. The risk of developing a VTE peaks at 6 days after pneumonectomy, and remains increased until 30 days, suggesting a need for additional screening or longer prophylaxis.
['Raja|Siva|S|', 'Idrees|Jay J|JJ|', 'Blackstone|Eugene H|EH|', 'He|Jiayan|J|', 'Badjatiya|Anish|A|', 'Mazzone|Peter|P|', 'Mason|David P|DP|', 'Rice|Thomas W|TW|', 'Raymond|Daniel P|DP|', 'Murthy|Sudish C|SC|']
D000368:Aged D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D035002:Lower Extremity D008297:Male D008875:Middle Aged D009820:Ohio D011013:Pneumonectomy D011237:Predictive Value of Tests D015995:Prevalence D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D018616:Ultrasonography, Doppler, Duplex D054556:Venous Thromboembolism
prophylaxis postoperative care quality improvement surveillance