What is the clinical evidence from this study?

Study design: Cohort. Population: Postoperative pulmonary embolism (n=4856597). Intervention: Dynamic PE risk reassessment vs. Discharge risk assessment. Primary outcome: 30-day postoperative PE (AUC 0.892, 95% CI 0.887-0.897).

What question did this study set out to answer?

This research aims to develop a calculator for assessing pulmonary embolism risk at discharge and after unplanned readmission or reoperation.

June 19, 2026Journal of the American College of Surgeons

Targeting Extended Thromboprophylaxis after Surgery Through Multidimensional Dynamic Pulmonary Embolism Risk Assessment: Development and Temporal Validation in 4.8 Million Operations

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Key result

Dynamic PE reassessment after readmission or reoperation improves risk discrimination, identifying a ~3% 30-day PE rate.

AUC 0.892
95% CI 0.887-0.897
n=4,856,597

Why the study?

Does a dynamic PE risk assessment calculator accurately predict 30-day postoperative PE in adult surgical patients?

Population

4,856,597 adult operations from ACS-NSQIP, split into development and temporal validation cohorts.

Design

Cohort

Follow-up

30-day

Authors

RDRamsey Michael DallalThomas Jefferson University JRJeffrey Riggio MLMichael LiThomas Jefferson University

Discussion

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Implication

Highlights a high-risk postoperative subgroup for PE; leaves open whether targeted interventions improve outcomes.

Key Points

This research aims to develop a calculator for assessing pulmonary embolism risk at discharge and after unplanned readmission or reoperation.
Utilized ACS-NSQIP data from 2020 to 2023 for development (n=3,864,605) and 2024 operations for temporal validation (n=956,434).
Employed penalized logistic regression for risk modeling based on patient, surgical, and postoperative variables.
Evaluated the risk threshold for thromboprophylaxis consideration at 0.5%.
Out of 4,856,597 operations, 17,045 patients developed pulmonary embolism (0.35%).
The discharge model showed an AUC of 0.811 (95% CI, 0.801–0.818), while dynamic reassessment improved to AUC 0.892 (95% CI, 0.887–0.897).
Reassessment identified 24,320 patients exceeding the treatment-threshold post-unplanned return, resulting in a 2.92% pulmonary embolism rate for that group.

Study Design

Type

Cohort (n=4,856,597)

Multicenter

Yes

Structured PICO

Does a dynamic PE risk assessment calculator accurately predict 30-day postoperative PE in adult surgical patients?

Population

4,856,597 adult operations from the ACS-NSQIP database evaluated to develop and validate a dynamic risk calculator for 30-day postoperative pulmonary embolism.

Exposure

Two-stage calculator to estimate pulmonary embolism (PE) risk at discharge and update risk after unplanned readmission or reoperation.

Outcome

30-day postoperative pulmonary embolism (PE)hard clinical

Main Result

Effect estimate: AUC 0.892 (95% CI 0.887-0.897)

A dynamic PE risk calculator incorporating unplanned readmission or reoperation significantly improves the identification of high-risk surgical patients who may benefit from extended thromboprophylaxis.

Cite This Study

Dallal et al. (2026) conducted a cohort in Postoperative pulmonary embolism (n=4,856,597). Dynamic PE risk reassessment vs. Discharge risk assessment was evaluated on 30-day postoperative PE (AUC 0.892, 95% CI 0.887-0.897). Dynamic PE reassessment after unplanned readmission or reoperation improved risk discrimination (AUC 0.892; 95% CI 0.887-0.897), identifying a high-risk group with a 2.92% 30-day PE rate.

synapsesocial.com/papers/6a35982fdd3be7785e70ed3a https://doi.org/10.1097/xcs.0000000000002074

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Targeting Extended Thromboprophylaxis after Surgery Through Multidimensional Dynamic Pulmonary Embolism Risk Assessment: Development and Temporal Validation in 4.8 Million Operations

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Targeting Extended Thromboprophylaxis after Surgery Through Multidimensional Dynamic Pulmonary Embolism Risk Assessment: Development and Temporal Validation in 4.8 Million Operations

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

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