Post-discharge venous thromboembolism after cancer surgery: Extending the case for extended prophylaxis

Ryan P. Merkow, Karl Y. Bilimoria, Martin D. McCarter, Mark E. Cohen, Carlton C. Barnett, Mehul V. Raval, Joseph A. Caprini, Howard S. Gordon, Clifford Y. Ko, David J. Bentrem

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

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), ascites, thrombocytosis (>400,000 cells/mm), albumin (<3.0 g/dL), and operation duration (>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.

Original languageEnglish (US)
Pages (from-to)131-137
Number of pages7
JournalAnnals of surgery
Volume254
Issue number1
DOIs
StatePublished - Jul 1 2011

Fingerprint

Venous Thromboembolism
Neoplasms
Logistic Models
Thrombocytosis
Mortality
Ambulatory Surgical Procedures
Ascites
Prostate
Albumins

ASJC Scopus subject areas

  • Surgery

Cite this

Merkow, Ryan P. ; Bilimoria, Karl Y. ; McCarter, Martin D. ; Cohen, Mark E. ; Barnett, Carlton C. ; Raval, Mehul V. ; Caprini, Joseph A. ; Gordon, Howard S. ; Ko, Clifford Y. ; Bentrem, David J. / Post-discharge venous thromboembolism after cancer surgery : Extending the case for extended prophylaxis. In: Annals of surgery. 2011 ; Vol. 254, No. 1. pp. 131-137.
@article{ca70338fd29a4b719f27a9cebd2ea2a8,
title = "Post-discharge venous thromboembolism after cancer surgery: Extending the case for extended prophylaxis",
abstract = "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), ascites, thrombocytosis (>400,000 cells/mm), albumin (<3.0 g/dL), and operation duration (>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.",
author = "Merkow, {Ryan P.} and Bilimoria, {Karl Y.} and McCarter, {Martin D.} and Cohen, {Mark E.} and Barnett, {Carlton C.} and Raval, {Mehul V.} and Caprini, {Joseph A.} and Gordon, {Howard S.} and Ko, {Clifford Y.} and Bentrem, {David J.}",
year = "2011",
month = "7",
day = "1",
doi = "10.1097/SLA.0b013e31821b98da",
language = "English (US)",
volume = "254",
pages = "131--137",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

Post-discharge venous thromboembolism after cancer surgery : Extending the case for extended prophylaxis. / Merkow, Ryan P.; Bilimoria, Karl Y.; McCarter, Martin D.; Cohen, Mark E.; Barnett, Carlton C.; Raval, Mehul V.; Caprini, Joseph A.; Gordon, Howard S.; Ko, Clifford Y.; Bentrem, David J.

In: Annals of surgery, Vol. 254, No. 1, 01.07.2011, p. 131-137.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Post-discharge venous thromboembolism after cancer surgery

T2 - Extending the case for extended prophylaxis

AU - Merkow, Ryan P.

AU - Bilimoria, Karl Y.

AU - McCarter, Martin D.

AU - Cohen, Mark E.

AU - Barnett, Carlton C.

AU - Raval, Mehul V.

AU - Caprini, Joseph A.

AU - Gordon, Howard S.

AU - Ko, Clifford Y.

AU - Bentrem, David J.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - 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), ascites, thrombocytosis (>400,000 cells/mm), albumin (<3.0 g/dL), and operation duration (>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.

AB - 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), ascites, thrombocytosis (>400,000 cells/mm), albumin (<3.0 g/dL), and operation duration (>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.

UR - http://www.scopus.com/inward/record.url?scp=79959517821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79959517821&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e31821b98da

DO - 10.1097/SLA.0b013e31821b98da

M3 - Article

C2 - 21527843

AN - SCOPUS:79959517821

VL - 254

SP - 131

EP - 137

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 1

ER -