d-dimer-based screening for early diagnosis of venous thromboembolism after hepatectomy

Purpose: The aim of this study was to evaluate the clinical utility of a novel diagnostic algorithm based on serum d-dimer levels for venous thromboembolism (VTE) after hepatectomy. Methods: We retrospectively analyzed 742 consecutive patients who underwent hepatectomy in our hospital from 2009 to 2019. From 2015, we routinely measured serum d-dimer level postoperatively and computed tomography was performed when d-dimer level was ≥ 20 μg/mL. Results: VTE was diagnosed in 26 patients and pulmonary embolism (PE) was diagnosed in 18 patients. Multivariate analysis revealed that resected liver weight ≥ 120 g is a significant predictor of VTE (P = 0.011). The incidence of VTE from 2015 to 2019 was greater than that from 2009 to 2014 (5.0% versus 2.1%, P = 0.044). The number of low-risk PE patients between 2015 and 2019 was significantly greater than that between 2009 and 2014 (P = 0.013). There was no in-hospital mortality of patients with PE from 2015 to 2019. Conclusion: Patients who undergo hepatectomy are at high risk for VTE, especially when the resected liver weight is high. The proposed diagnostic algorithm based on serum d-dimer levels for VTE after hepatectomy can be useful for early diagnosis.