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.
N1 - Funding Information:
This study was supported by the Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc) of the Robert H. Lurie Comprehensive Cancer Center. ADY is supported by the National Heart, Lung and Blood Institute (K08HL145139), DJB is supported by the Veteran’s Administration Health Services Research and Development Program (I01HX002290), KYB is supported by the Agency for Healthcare Research and Quality (R01HS024516), and RPM is supported by the Agency for Healthcare Research and Quality (K12HS026385) and an Institutional Research Grant from the American Cancer Society (IRG-18-163-24).
Publisher Copyright:
© 2019, The Society for Surgery of the Alimentary Tract.
PY - 2020/1/1
Y1 - 2020/1/1
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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UR - http://www.scopus.com/inward/citedby.url?scp=85071008130&partnerID=8YFLogxK
U2 - 10.1007/s11605-019-04354-2
DO - 10.1007/s11605-019-04354-2
M3 - Article
C2 - 31420856
AN - SCOPUS:85071008130
SN - 1091-255X
VL - 24
SP - 144
EP - 154
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 1
ER -
