Pre-Operative, Intra-Operative, and Post-Operative Factors Associated with Post-Discharge Venous Thromboembolism Following Colorectal Cancer Resection

Cary Jo R. Schlick, Jessica Y. Liu, Anthony D. Yang, David J. Bentrem, Karl Y. Bilimoria, Ryan P. Merkow*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator. Methods: Patients who underwent colorectal cancer resection from 2012 to 2016 were identified from ACS NSQIP colectomy and proctectomy procedure–targeted modules. Multivariable logistic regression was used to identify factors associated with post-discharge VTE. Incorporating pre-operative, intra-operative, and post-operative variables, a post-discharge VTE risk calculator was constructed and validated. Results: Of 51,139 patients, 387 (0.76%) developed post-discharge VTE. Pre-operative factors associated with post-discharge VTE included BMI (e.g., morbidly obese OR 2.27, 95% CI 1.65–3.12 vs. normal BMI), and thrombocytosis (OR 1.41, 95% CI 1.03–1.92). Intra-operative factors included operative time (4–6 h OR 1.56, 95% CI 1.12–2.17; > 6 h, OR 1.85, 95% CI 1.21–2.84, vs. < 2 h), and type of operation (e.g., open partial colectomy OR 1.67, 95% CI 1.30–2.16 vs. laparoscopic partial colectomy). Post-operative factors included anastomotic leak (OR 2.05, 95% CI 1.31–3.21) and post-operative ileus (OR 1.39, 95% CI 1.07–1.79). Using the risk calculator, the predicted probability of post-discharge VTE ranged from 0.04 to 10.29%. On a 10-fold cross validation, the calculator’s mean C-Statistic was 0.65. Conclusions: Patient-specific factors are associated with varying rates of post-discharge VTE. We present the first post-discharge VTE risk calculator designed for use at the time of discharge following colorectal cancer resection.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Venous Thromboembolism
Colorectal Neoplasms
Colectomy
Pelvic Neoplasms
Thrombocytosis
Anastomotic Leak
Ileus
Chemoprevention
Operative Time
Logistic Models

Keywords

  • ACS NSQIP
  • Colorectal cancer
  • Post-discharge VTE
  • VTE risk calculator
  • Venous thromboembolism

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{a2ec1beb3301476388db725822cc2d7f,
title = "Pre-Operative, Intra-Operative, and Post-Operative Factors Associated with Post-Discharge Venous Thromboembolism Following Colorectal Cancer Resection",
abstract = "Background: Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator. Methods: Patients who underwent colorectal cancer resection from 2012 to 2016 were identified from ACS NSQIP colectomy and proctectomy procedure–targeted modules. Multivariable logistic regression was used to identify factors associated with post-discharge VTE. Incorporating pre-operative, intra-operative, and post-operative variables, a post-discharge VTE risk calculator was constructed and validated. Results: Of 51,139 patients, 387 (0.76{\%}) developed post-discharge VTE. Pre-operative factors associated with post-discharge VTE included BMI (e.g., morbidly obese OR 2.27, 95{\%} CI 1.65–3.12 vs. normal BMI), and thrombocytosis (OR 1.41, 95{\%} CI 1.03–1.92). Intra-operative factors included operative time (4–6 h OR 1.56, 95{\%} CI 1.12–2.17; > 6 h, OR 1.85, 95{\%} CI 1.21–2.84, vs. < 2 h), and type of operation (e.g., open partial colectomy OR 1.67, 95{\%} CI 1.30–2.16 vs. laparoscopic partial colectomy). Post-operative factors included anastomotic leak (OR 2.05, 95{\%} CI 1.31–3.21) and post-operative ileus (OR 1.39, 95{\%} CI 1.07–1.79). Using the risk calculator, the predicted probability of post-discharge VTE ranged from 0.04 to 10.29{\%}. On a 10-fold cross validation, the calculator’s mean C-Statistic was 0.65. Conclusions: Patient-specific factors are associated with varying rates of post-discharge VTE. We present the first post-discharge VTE risk calculator designed for use at the time of discharge following colorectal cancer resection.",
keywords = "ACS NSQIP, Colorectal cancer, Post-discharge VTE, VTE risk calculator, Venous thromboembolism",
author = "Schlick, {Cary Jo R.} and Liu, {Jessica Y.} and Yang, {Anthony D.} and Bentrem, {David J.} and Bilimoria, {Karl Y.} and Merkow, {Ryan P.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11605-019-04354-2",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Pre-Operative, Intra-Operative, and Post-Operative Factors Associated with Post-Discharge Venous Thromboembolism Following Colorectal Cancer Resection

AU - Schlick, Cary Jo R.

AU - Liu, Jessica Y.

AU - Yang, Anthony D.

AU - Bentrem, David J.

AU - Bilimoria, Karl Y.

AU - Merkow, Ryan P.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator. Methods: Patients who underwent colorectal cancer resection from 2012 to 2016 were identified from ACS NSQIP colectomy and proctectomy procedure–targeted modules. Multivariable logistic regression was used to identify factors associated with post-discharge VTE. Incorporating pre-operative, intra-operative, and post-operative variables, a post-discharge VTE risk calculator was constructed and validated. Results: Of 51,139 patients, 387 (0.76%) developed post-discharge VTE. Pre-operative factors associated with post-discharge VTE included BMI (e.g., morbidly obese OR 2.27, 95% CI 1.65–3.12 vs. normal BMI), and thrombocytosis (OR 1.41, 95% CI 1.03–1.92). Intra-operative factors included operative time (4–6 h OR 1.56, 95% CI 1.12–2.17; > 6 h, OR 1.85, 95% CI 1.21–2.84, vs. < 2 h), and type of operation (e.g., open partial colectomy OR 1.67, 95% CI 1.30–2.16 vs. laparoscopic partial colectomy). Post-operative factors included anastomotic leak (OR 2.05, 95% CI 1.31–3.21) and post-operative ileus (OR 1.39, 95% CI 1.07–1.79). Using the risk calculator, the predicted probability of post-discharge VTE ranged from 0.04 to 10.29%. On a 10-fold cross validation, the calculator’s mean C-Statistic was 0.65. Conclusions: Patient-specific factors are associated with varying rates of post-discharge VTE. We present the first post-discharge VTE risk calculator designed for use at the time of discharge following colorectal cancer resection.

AB - Background: Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator. Methods: Patients who underwent colorectal cancer resection from 2012 to 2016 were identified from ACS NSQIP colectomy and proctectomy procedure–targeted modules. Multivariable logistic regression was used to identify factors associated with post-discharge VTE. Incorporating pre-operative, intra-operative, and post-operative variables, a post-discharge VTE risk calculator was constructed and validated. Results: Of 51,139 patients, 387 (0.76%) developed post-discharge VTE. Pre-operative factors associated with post-discharge VTE included BMI (e.g., morbidly obese OR 2.27, 95% CI 1.65–3.12 vs. normal BMI), and thrombocytosis (OR 1.41, 95% CI 1.03–1.92). Intra-operative factors included operative time (4–6 h OR 1.56, 95% CI 1.12–2.17; > 6 h, OR 1.85, 95% CI 1.21–2.84, vs. < 2 h), and type of operation (e.g., open partial colectomy OR 1.67, 95% CI 1.30–2.16 vs. laparoscopic partial colectomy). Post-operative factors included anastomotic leak (OR 2.05, 95% CI 1.31–3.21) and post-operative ileus (OR 1.39, 95% CI 1.07–1.79). Using the risk calculator, the predicted probability of post-discharge VTE ranged from 0.04 to 10.29%. On a 10-fold cross validation, the calculator’s mean C-Statistic was 0.65. Conclusions: Patient-specific factors are associated with varying rates of post-discharge VTE. We present the first post-discharge VTE risk calculator designed for use at the time of discharge following colorectal cancer resection.

KW - ACS NSQIP

KW - Colorectal cancer

KW - Post-discharge VTE

KW - VTE risk calculator

KW - Venous thromboembolism

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U2 - 10.1007/s11605-019-04354-2

DO - 10.1007/s11605-019-04354-2

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JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

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