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Related Concept Videos

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
Pulmonary Embolism III: Nursing Management01:27

Pulmonary Embolism III: Nursing Management

A pulmonary embolism occurs when a thrombus, amniotic fluid, tumor tissue, fat, or air embolus blocks one or more pulmonary arteries. Effective nursing management and patient education are crucial for improving outcomes and preventing recurrence.Nursing management starts with obtaining a comprehensive patient history, particularly noting any history of deep vein thrombosis (DVT). Assess for clinical manifestations, including dyspnea, chest pain, crackles, heart murmurs, and signs of right-sided...
Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Pulmonary Embolism I: Introduction01:19

Pulmonary Embolism I: Introduction

A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...
Pulmonary Embolism I: Introduction01:29

Pulmonary Embolism I: Introduction

Pulmonary embolism (PE) occurs when a thrombus, fat or air embolus, amniotic fluid, or tumor tissue blocks one or more pulmonary arteries. These blockages originate in the venous system or the right side of the heart.EtiologyPE primarily arises from deep vein thrombosis (DVT) and other hypercoagulable states, such as inherited thrombophilias. Additional etiological factors include venous stasis, commonly seen in obesity, and endothelial injury from surgery and trauma. Less common causes include...
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...

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Related Experiment Videos

Targeting Extended Thromboprophylaxis after Surgery Through Multidimensional Dynamic Pulmonary Embolism Risk

Ramsey M Dallal1, Jeffrey Riggio2, Michael Li3

  • 1Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Dallal, Moran).

Journal of the American College of Surgeons
|June 19, 2026
PubMed
Summary
This summary is machine-generated.

A new calculator dynamically reassesses pulmonary embolism (PE) risk after surgery, especially after readmission or reoperation. This tool helps identify high-risk patients for extended thromboprophylaxis when prevention is still possible.

Keywords:
dynamic risk assessmentextended thromboprophylaxispostoperative complicationspulmonary embolismrisk predictionvenous thromboembolism

Related Experiment Videos

Area of Science:

  • Medical Informatics
  • Surgical Outcomes
  • Thromboprophylaxis

Background:

  • Extended thromboprophylaxis is crucial for reducing postoperative venous thromboembolism (VTE).
  • Pulmonary embolism (PE) risk varies significantly post-surgery and is challenging to predict at discharge.
  • Current methods for risk assessment are inconsistent, leading to underutilization of preventative measures.

Purpose of the Study:

  • To develop and validate a dynamic calculator for estimating PE risk post-discharge.
  • To identify patients who may benefit from extended thromboprophylaxis after unplanned readmissions or reoperations.
  • To improve the reproducibility of extended prophylaxis decisions in surgical patients.

Main Methods:

  • Utilized data from 4,856,597 adult operations from the ACS-NSQIP database (2020-2024).
  • Developed a two-stage calculator: one for discharge risk and another for dynamic reassessment post-unplanned return.
  • Employed penalized logistic regression, modeling PE risk using patient, surgical, and postoperative variables, including timing of readmission/reoperation.

Main Results:

  • The initial discharge model showed good discrimination (AUC 0.811).
  • Dynamic reassessment significantly improved PE risk prediction (AUC 0.892).
  • Among patients with unplanned returns, 24,320 were reclassified above the 0.5% PE risk threshold, identifying a high-risk group with a 2.92% PE rate.

Conclusions:

  • Dynamic PE risk reassessment following unplanned readmission or reoperation effectively identifies high-risk surgical patients.
  • This calculator provides an actionable tool for surgeons to reconsider extended prophylaxis when prevention is feasible.
  • The timing of unplanned return, not the specific postoperative day, is a key predictor of sustained PE risk.