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

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery

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.

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Funding

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).

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Authors and Affiliations

  1. Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

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

  2. Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc) of the Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA

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

  3. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Jessica Y. Liu, Karl Y. Bilimoria & Ryan P. Merkow

  4. Surgery Service, Jesse Brown VA Medical Center, Chicago, IL, USA

    David J. Bentrem

Authors
  1. Cary Jo R. Schlick
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  2. Jessica Y. Liu
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  5. Karl Y. Bilimoria
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Contributions

CRS, JYL, ADY, DJB, KYB, and RPM conceived and designed the study.

CRS and JYL collected and analyzed the data.

CRS, JYL, ADY, DJB, KYB, and RPM interpreted the data.

CRS drafted the manuscript.

JYL, ADY, DJB, KYB, and RPM critically revised the manuscript.

CRS, JYL, ADY, DJB, KYB, and RPM have made final approval of this version and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Ryan P. Merkow.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Presentation

Presented at the Society of Surgeons of the Alimentary Tract Small Bowel and Colorectal Plenary Session; San Diego, CA; May 21, 2019.

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Schlick, C.J.R., Liu, J.Y., Yang, A.D. et al. Pre-Operative, Intra-Operative, and Post-Operative Factors Associated with Post-Discharge Venous Thromboembolism Following Colorectal Cancer Resection. J Gastrointest Surg 24, 144–154 (2020). https://doi.org/10.1007/s11605-019-04354-2

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