Skip to main content

Advertisement

SpringerLink
Log in

Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Extended thromboprophylaxis after abdominal and pelvic cancer surgery to prevent venous thromboembolic events (VTE) is recommended but adherence is sub-optimal. Identifying patients at highest risk for post-discharge events may allow for selective extended thromboprophylaxis. The aim of our study was to identify the different risk factors of venous thromboembolism for in-hospital and post-discharge events.

Methods

The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2012–2016 database was queried for all patients having colorectal resection. Primary outcome was postoperative VTE occurrence within 30 days. A multinomial logistic regression was performed to identify in-hospital and post-discharge predictors of VTE, adjusting for potential confounders.

Results

Out of 260,258 patients, 5381 (2.1%) developed VTE. A total of 3442 (1.3%) were diagnosed during the initial hospital stay and 1929 (0.8%) post-discharge. Risk factors for in-hospital and post-discharge VTE were different as patients with an in-hospital event were more likely to be older, male, known for preoperative steroid use, have poor functional status, significant weight loss, preoperative sepsis, prolonged operative time, undergoing an emergency operation. In the post-discharge setting, steroid use, poor functional status, preoperative sepsis, and postoperative complications remained significant. Postoperative complications were the strongest predictor of in-hospital and post-discharge VTE. Patients with inflammatory bowel disease had a higher risk of VTE than patients with malignancy for both in-patient and post-discharge events.

Conclusions

Patients at high-risk for post-discharge events have different characteristics than those who develop VTE in-hospital. Identifying this specific subset of patients at highest risk for post-discharge VTE may allow for the selective use of prolonged thromboprophylaxis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vedovati MC et al (2014) A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann Surg 259(4):665–669

    Article  Google Scholar 

  2. Fleming F et al (2018) The American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Prevention of Venous Thromboembolic Disease in Colorectal Surgery. Dis Colon Rectum 61(1):14–20

    Article  Google Scholar 

  3. McLeod RS et al (2001) Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg 233(3):438–444

    Article  CAS  Google Scholar 

  4. Gross ME et al (2014) The importance of extended postoperative venous thromboembolism prophylaxis in IBD: a National Surgical Quality Improvement Program analysis. Dis Colon Rectum 57(4):482–489

    Article  Google Scholar 

  5. Murthy SK, Nguyen GC (2011) Venous thromboembolism in inflammatory bowel disease: an epidemiological review. Am J Gastroenterol 106(4):713–718

    Article  Google Scholar 

  6. Wallaert JB et al (2012) Venous thromboembolism after surgery for inflammatory bowel disease: are there modifiable risk factors? Data from ACS NSQIP. Dis Colon Rectum 55(11):1138–1144

    Article  Google Scholar 

  7. Gould MK et al., Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012. 141(2 Suppl):e227S–e277S

    Article  CAS  Google Scholar 

  8. Fleming FJ et al (2010) How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum 53(10):1355–1360

    Article  Google Scholar 

  9. Agnelli G et al (2006) A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg 243(1):89–95

    Article  Google Scholar 

  10. Lyman GH et al (2013) Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 31(17):2189–2204

    Article  CAS  Google Scholar 

  11. Lyman GH et al (2015) Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol 33(6):654–656

    Article  CAS  Google Scholar 

  12. Selby LV et al (2016) Preoperative chemoprophylaxis is safe in major oncology operations and effective at preventing venous thromboembolism. J Am Coll Surg 222(2):129–137

    Article  Google Scholar 

  13. Amin AN et al (2011) Inpatient and outpatient occurrence of deep vein thrombosis and pulmonary embolism and thromboprophylaxis following selected at-risk surgeries. Ann Pharmacother 45(9):1045–1052

    Article  Google Scholar 

  14. Surgeons AC.o. ACS NSQIP Participant Use Data File (2018) April 2, 2018]; https://www.facs.org/quality-programs/acs-nsqip/program-specifics/participant-use

  15. Buchberg B et al (2011) Incidence and risk factors of venous thromboembolism in colorectal surgery: does laparoscopy impart an advantage? Arch Surg 146(6):739–743

    Article  Google Scholar 

  16. Shapiro R, Vogel JD, Kiran RP (2011) Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach? Dis Colon Rectum 54(12):1496–1502

    Article  Google Scholar 

  17. Nguyen NT et al (2007) Laparoscopic surgery is associated with a lower incidence of venous thromboembolism compared with open surgery. Ann Surg 246(6):1021–1027

    Article  Google Scholar 

  18. Guo Q et al (2017) Perioperative pharmacological thromboprophylaxis in patients with cancer: a systematic review and meta-analysis. Ann Surg 265(6):1087–1093

    Article  Google Scholar 

  19. Vendler MMI et al (2017) Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population-based cohort study. Colorectal Dis 19(11):O393–O401

    Article  CAS  Google Scholar 

  20. El-Dhuwaib Y et al (2017) Venous thromboembolism following colorectal resection. Colorectal Dis 19(4):385–394

    Article  CAS  Google Scholar 

  21. McKenna NP et al (2017) Analysis of postoperative venous thromboembolism in patients with chronic ulcerative colitis: is it the disease or the operation? Dis Colon Rectum 60(7):714–722

    Article  Google Scholar 

  22. Ali F et al (2018) Elevated venous thromboembolism risk following colectomy for IBD is equal to those for colorectal cancer for ninety days after surgery. Dis Colon Rectum 61(3):375–381

    Article  Google Scholar 

  23. Tagalakis V et al (2013) Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med 126(9):832 e13–21

    Article  Google Scholar 

  24. Gussoni G et al (2013) Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer. Findings from the RIETE registry. Thromb Res 131(1):24–30

    Article  CAS  Google Scholar 

  25. Alsubaie H et al (2015) Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice. Can J Surg 58(5):305–311

    Article  Google Scholar 

  26. Hanna N et al (2012) Impact of venous thromboembolism on mortality of elderly Medicare patients with stage III colon cancer. Oncologist 17(9):1191–1197

    Article  Google Scholar 

  27. Fanikos J et al (2013) Hospital costs of acute pulmonary embolism. Am J Med 126(2):127–132

    Article  Google Scholar 

  28. Merli G et al., Hospital-based costs associated with venous thromboembolism treatment regimens. J Thromb Haemost, 2008. 6(7):1077–1086

  29. Amin AN, Lin J, Ryan A (2010) Need to improve thromboprophylaxis across the continuum of care for surgical patients. Adv Ther 27(2):81–93

    Article  Google Scholar 

  30. Merkow RP et al (2014) Adherence with postdischarge venous thromboembolism chemoprophylaxis recommendations after colorectal cancer surgery among elderly Medicare beneficiaries. Ann Surg 260(1):103–108

    Article  Google Scholar 

  31. Bradley CT et al (2010) Cost-effectiveness of prolonged thromboprophylaxis after cancer surgery. Ann Surg Oncol 17(1):31–39

    Article  Google Scholar 

  32. Iannuzzi JC et al (2014) Defining high risk: cost-effectiveness of extended-duration thromboprophylaxis following major oncologic abdominal surgery. J Gastrointest Surg 18(1):60–68

    Article  Google Scholar 

  33. Sarasin FP, Bounameaux H (1996) Cost-effectiveness of prophylactic anticoagulation prolonged after hospital discharge following general surgery. Arch Surg 131(7):694–697; discussion 698

    Article  CAS  Google Scholar 

  34. Berian JR et al (2018) Association of an enhanced recovery pilot with length of stay in the national surgical quality improvement program. JAMA Surg 153(4):358–365

    Article  Google Scholar 

  35. Kwon S et al (2011) Perioperative pharmacologic prophylaxis for venous thromboembolism in colorectal surgery. J Am Coll Surg 213(5):596–603, 603 e1

    Article  Google Scholar 

  36. Colorectal Writing Group for Surgical (2015) thromboembolic complications and prophylaxis patterns in colorectal surgery. JAMA Surg 150(8):712–720

    Article  Google Scholar 

  37. Alcalay A et al (2006) Venous thromboembolism in patients with colorectal cancer: incidence and effect on survival. J Clin Oncol 24(7):1112–1118

    Article  Google Scholar 

  38. Grainge MJ, West J, Card TR (2010) Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet 375(9715):657–663

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada

    N. Alhassan, M. Trepanier, A. S. Liberman, P. Charlebois, B. L. Stein & L. Lee

  2. Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    N. Alhassan

  3. Division of Hematology and Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Canada

    C. Sabapathy

  4. Department of Surgery, McGill University Health Centre, McGill University Health Centre, Montreal, Canada

    P. Chaudhury, A. S. Liberman, P. Charlebois, B. L. Stein & L. Lee

Authors
  1. N. Alhassan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Trepanier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Sabapathy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Chaudhury
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. S. Liberman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Charlebois
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B. L. Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design of study: Alhassan, Trepanier. Acquisition of data: Alhassan, Chaudhury, Lee. Analysis and/or interpretation of data: Alhassan, Trepanier, Sabapathy, Chaudhury, Liberman, Charlebois, Stein, Lee. Drafting of manuscript: Alhassan, Trepanier. Revising the manuscript for critical content: Sabapathy, Chaudhury, Liberman, Charlebois, Stein, Lee. Approval of the final version to be published: Alhassan, Trepanier, Sabapathy, Chaudhury, Liberman, Charlebois, Stein, Lee.

Corresponding author

Correspondence to L. Lee.

Ethics declarations

Conflict of interest

Dr. Liberman is on the medical advisory committee on ERAS for Merck, and on the advisory committee meeting for Novadaq. Dr. Lee is the recipient of an unrestricted educational grant from Johnson & Johnson. Drs. Alhassan, Trepanier, Sabapathy, Chaudhury, Charlebois, and Stein have no conflicts of interest or financial ties to disclose.

Ethical approval

The study protocol was approved by the local institutional review board.

Informed consent

The need for informed consent was waived due to the retrospective nature of the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alhassan, N., Trepanier, M., Sabapathy, C. et al. Risk factors for post-discharge venous thromboembolism in patients undergoing colorectal resection: a NSQIP analysis. Tech Coloproctol 22, 955–964 (2018). https://doi.org/10.1007/s10151-018-1909-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-018-1909-8

Keywords

Search

Navigation