Venous thromboembolism occurred in 1.6% of cancer surgery patients within 30 days, with 33.4% of events occurring postdischarge, and was associated with increased mortality (8.0% vs 1.3%; P<0.001).
Cohort (n=44,656)
Yes
One-third of VTE events in cancer surgery patients occur postdischarge, and VTE is associated with a >6-fold increase in mortality, highlighting the potential need for routine postdischarge prophylaxis in high-risk patients.
OBJECTIVE: To (1) define the frequency of overall and postdischarge venous thromboembolism (VTE) after cancer surgery, (2) identify VTE risk for individual cancer operations, and (3) assess mortality rates in patients who experienced a VTE. SUMMARY AND BACKGROUND DATA: Cancer is a known risk factor for VTE but less is known about VTE risk after specific cancer operations. Moreover, most cancer patients routinely receive VTE prophylaxis postoperatively while in the hospital, but few receive prolonged prophylaxis despite strong evidence it reduces postdischarge events. METHODS: From 211 ACS NSQIP hospitals, 44,656 patients undergoing surgery for 9 cancers were identified (2006-2008). The frequency of VTE within 30-days of surgery was evaluated by cancer site and categorized as occurring before or after discharge. Multivariable logistic regression models were constructed to assess risk factors associated with VTE. RESULTS: VTE occurred in 1.6% of all patients, most frequently after esophagogastric (4.2%) and hepatopancreaticobiliary (3.6%) surgery. Overall, 33.4% of VTEs occurred postdischarge (from 17.9% for esophagogastric to 100% for endocrine operations). Factors associated with VTE were age (≥65 years), cancer/procedure type, metastatic disease, congestive heart failure, body mass index (BMI; ≥25 kg/m(2)), ascites, thrombocytosis (>400,000 cells/mm(3)), albumin (2 hours; all P < 0.001). Overall VTE was significantly more likely after gastrointestinal, lung, prostate, and ovarian/uterine operations (all P < 0.001). In those experiencing a VTE, mortality increased over 6-fold (8.0% vs. 1.3%; P < 0.001). CONCLUSION: One-third of VTE events in cancer surgery patients occurred postdischarge. Postoperative VTE was associated with operation type. Routine postdischarge VTE prophylaxis should be considered for high-risk patients.
Merkow et al. (Thu,) conducted a cohort in Cancer surgery (n=44,656). Cancer surgery was evaluated on Venous thromboembolism (VTE) within 30-days of surgery. Venous thromboembolism occurred in 1.6% of cancer surgery patients within 30 days, with 33.4% of events occurring postdischarge, and was associated with increased mortality (8.0% vs 1.3%; P<0.001).
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