Risk factors for perioperative venous thromboembolism in patients undergoing colorectal cancer surgery

Q: What are the key findings of this study?

Preoperative and postoperative VTE each occurred in 2.3% of colorectal cancer surgery patients, with age ≥75, female sex, low albumin/Hb, surgical ≥240 min, and blood loss ≥50 mL as key risk factors.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Colorectal cancer undergoing elective surgical resection (n=397). Intervention: Perioperative clinical and surgical risk factors (age ≥75 years, female sex, albumin <3.5 g/dL, hemoglobin <10 g/dL, operative time ≥240 minutes, intraoperative blood loss ≥50 mL) vs. Absence of respective perioperative risk factors. Primary outcome: Perioperative venous thromboembolism (preoperative VTE and postoperative VTE including deep vein thrombosis and pulmonary embolism) (p=<0.05).

Q: What does this research mean for the field?

Advanced age, female sex, hypoalbuminemia, and anemia are associated with preoperative venous thromboembolism, while prolonged operative time and higher intraoperative blood loss are associated with postoperative venous thromboembolism in colorectal cancer surgery. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To identify perioperative risk factors associated with venous thromboembolism in patients undergoing elective colorectal cancer surgery to guide targeted risk stratification and prevention.

Hiroe Kitahara; Masaki Yoshimura; Yukihiko Karasawa

doi:10.1097/md.0000000000051369

October 30, 2026Open Access

Risk factors for perioperative venous thromboembolism in patients undergoing colorectal cancer surgery

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Key result

Perioperative VTE affects ~2.3% of colorectal cancer surgery patients, linked to identifiable clinical risk factors.

P<0.05
n=397

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Why the study?

Although guidelines recommend venous thromboembolism prophylaxis after colorectal cancer surgery, bleeding risks complicate decision-making and evidence on perioperative risk factors in Japanese patients remains limited.

Key Points

To identify perioperative risk factors associated with venous thromboembolism in patients undergoing elective colorectal cancer surgery to guide targeted risk stratification and prevention.
Retrospective analysis of 397 patients undergoing elective colorectal cancer resection at a single center between June 2014 and May 2024.
Preoperative and postoperative D-dimer levels were measured, followed by selective lower extremity venous ultrasonography and contrast-enhanced computed tomography when indicated.
Univariate analyses were performed to identify clinical variables associated with preoperative and postoperative venous thromboembolism (P < .05 considered statistically significant).
Preoperative venous thromboembolism occurred in 9 of 397 patients (2.3%), with univariate analysis identifying female gender (P = .016), age ≥ 75 years (P = .048), albumin < 3.5 g/dL (P = .035), and hemoglobin < 10 g/dL (P = .035) as significant factors.
Postoperative venous thromboembolism occurred in 9 of 388 patients (2.3%), and was significantly associated with operative time ≥ 240 minutes and intraoperative blood loss ≥ 50 mL.
All 9 preoperative cases were asymptomatic (9 deep vein thrombosis, 2 pulmonary embolism), whereas postoperative events included 8 deep vein thrombosis and 4 pulmonary embolism cases, 1 of which was symptomatic.

Study Design

Type

Cohort (n=397)

Multicenter

No

Structured PICO

P

Population

397 Japanese patients (48.1% female, 47.9% aged ≥75 years) undergoing elective colorectal cancer resection at a single center between June 2014 and May 2024, screened perioperatively with D-dimer and lower extremity venous ultrasonography.

E

Exposure

Perioperative VTE screening (preoperative D-dimer cutoff >1.0 μg/mL, postoperative D-dimer cutoff >10.0 μg/mL on days 1, 3, and 7, followed by lower extremity venous ultrasonography and contrast-enhanced CT if DVT detected) and thromboprophylaxis (intermittent pneumatic compression, elastic stockings, and subcutaneous enoxaparin 2000 IU twice daily or once daily for CrCl 30-50 mL/min from postoperative day 1 to day 7).

O

Outcome

Incidence of and risk factors for perioperative venous thromboembolism (deep vein thrombosis and pulmonary embolism), evaluated preoperatively and postoperatively up to day 7.hard clinical

Main Result

p-value: p=<0.05

Limitations

Limited number of VTE events (9 preoperative and 9 postoperative), precluding multivariate and ROC curve analyses
Empirical data-dependent selection of cutoff values for continuous variables (particularly intraoperative blood loss ≥50 mL)
Multiple univariate comparisons performed without adjustment for multiple testing
Retrospective single-center design and selective postoperative ultrasonography screening only for D-dimer ≥10.0 μg/mL, potentially introducing selection and detection biases
Time-varying confounding due to an increasing proportion of laparoscopic surgeries over the 10-year study period
Small number of VTE events (9 preoperative and 9 postoperative), precluding multivariate and ROC curve analyses
Empirical data-dependent selection of cutoff values for continuous variables (especially blood loss ≥50 mL) and lack of adjustment for multiple comparisons
Retrospective single-center design and selective postoperative ultrasound screening (only for D-dimer ≥10.0 μg/mL), introducing potential selection and detection biases

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Implication

In Japanese patients undergoing colorectal cancer surgery, advanced age, female sex, hypoalbuminemia, and anemia were associated with preoperative VTE, whereas prolonged operative time and increased blood loss were associated with postoperative VTE, supporting targeted perioperative risk stratification.

Abstract

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a serious perioperative complication after colorectal cancer surgery. Although guidelines recommend prophylaxis, bleeding risks complicate decision-making, and evidence regarding Japanese patients remains limited. Therefore, this study aimed to identify perioperative risk factors associated with VTE in colorectal cancer surgery to inform effective risk stratification and targeted prevention strategies. A retrospective analysis of 397 patients who underwent elective colorectal cancer resection at a single institution between June 2014 and May 2024 was conducted. Preoperative and postoperative D-dimer levels were measured, and lower extremity venous ultrasonography was performed when indicated. When deep vein thrombosis was detected by venous ultrasonography, contrast-enhanced computed tomography was subsequently performed to evaluate the presence of pulmonary embolism. Univariate analyses were used to determine factors significantly associated with VTE, and a P-value < .05 was considered statistically significant. Preoperative VTE was observed in nine of 397 patients (2.3%), and postoperative VTE was observed in nine of 388 patients (2.3%). The univariate analysis suggested that age ≥75 years, female gender, albumin levels < 3.5 g/dL, and hemoglobin levels < 10 g/dL were significantly associated with preoperative VTE, while operative time ≥ 240 minutes and intraoperative blood loss ≥ 50 mL were significantly associated with postoperative VTE. Advanced age, female gender, hypoalbuminemia, anemia, prolonged operative time, and increased intraoperative blood loss were significantly associated with perioperative VTE in univariate analysis. Effective perioperative risk stratification and targeted surveillance may contribute to the early detection and prevention of VTE in Japanese patients undergoing colorectal cancer surgery.

Discussion

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Cite This Study

Kitahara et al. (2026) conducted a cohort in Colorectal cancer undergoing elective surgical resection (n=397). Perioperative clinical and surgical risk factors (age ≥75 years, female sex, albumin <3.5 g/dL, hemoglobin <10 g/dL, operative time ≥240 minutes, intraoperative blood loss ≥50 mL) vs. Absence of respective perioperative risk factors was evaluated on Perioperative venous thromboembolism (preoperative VTE and postoperative VTE including deep vein thrombosis and pulmonary embolism) (p=<0.05). Preoperative and postoperative VTE each occurred in 2.3% of colorectal cancer surgery patients, with age ≥75, female sex, low albumin/Hb, surgical ≥240 min, and blood loss ≥50 mL as key risk factors.

synapsesocial.com/papers/6aee6bc771a7594806220b1b https://doi.org/10.1097/md.0000000000051369

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Risk factors for perioperative venous thromboembolism in patients undergoing colorectal cancer surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Risk factors for perioperative venous thromboembolism in patients undergoing colorectal cancer surgery

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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