Readmission rates due to venous thromboembolism in cancer patients after abdominopelvic surgery, a retrospective chart review

White, Christine Klimowicz; Langholtz, Jessica; Burns, Zackory T.; Kruse, Susan; Sallee, Kimberly; Henry, David H.

doi:10.1007/s00520-014-2448-0

Cited by 7 publications

(4 citation statements)

References 19 publications

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“…Reasons for exclusion are in Figure . Eleven articles reported the incidence of VTE at 3 months (primary outcome) following surgery . However, we were able to find 13 articles that reported the incidence of VTE at 1 month from surgery (secondary outcome).…”

Section: Resultsmentioning

confidence: 93%

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Serrano

Parpia

Valencia

et al. 2019

ANZ Journal of Surgery

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Background: Incidence of venous thromboembolism (VTE) following discharge for abdominal cancer surgery is uncertain. Methods: We searched MEDLINE and Embase for studies evaluating the incidence of VTE at 3 months from surgery. Studies indicating use of post-hospital VTE prophylaxis were excluded. Two independent reviewers performed study selection, data abstraction and risk of bias. Random-effects model was used to estimate pooled incidence, and weights were estimated using inverse variance method. Statistical heterogeneity was explored via subgroup analysis. Results: Of 4215 abstracts retrieved, 11 reported the incidence of VTE at 3 months. There were three randomized trials (n = 520), one prospective cohort study (n = 284) and seven retrospective cohort studies (n = 65 308). VTE incidence among prospective studies was 9.6% (95% confidence interval (CI) 2.9-16.4), while for retrospective studies was 2.2% (95% CI 1.4-3.0). Heterogeneity was high (I 2 = 92% and 81%, respectively). The incidence of symptomatic VTE was 1.3% (95% CI 0.4-2.3) for prospective studies. VTE was diagnosed by screening venography in most of the prospective studies, whereas retrospective studies did not use a screening method. Subgroup analysis based on the type of organ surgery performed explained the heterogeneity. Conclusions: VTE incidence following abdominal cancer surgery varies greatly depending on the study type, with differences largely explained by the method of assessment of VTE. The fact that VTE incidence among retrospective studies was closer to the incidence of symptomatic events (non-screen detected) in the prospective studies, suggests that the screened events were mostly asymptomatic and their clinical significance is unclear.

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Section: Resultsmentioning

confidence: 93%

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Serrano

Parpia

Valencia

et al. 2019

ANZ Journal of Surgery

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“…29 In fact, recent studies linked NAID to several postoperative adverse outcomes. For instance, NAID was shown to be associated with an increased risk of thrombocytosis in oncologic patients, 30,31 which itself is an independent risk factor for thromboembolic events. 32 Moreover, NAID is independently associated with worse functional status in congestive heart failure 33 and with poorer outcomes in elective cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels—a randomized controlled trial

Assouline

Benoliel

Zamberg

et al. 2021

Surgery

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Background: Anemia is a recognized risk factor for perioperative related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. We aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery. Methods: The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery. Results: The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group (11.1 ± 1.8 g/dL and 10.4 ± 1.6 g/dL, respectively) with a mean difference of þ0.7 g/dL ([95% confidence interval, À0.3 to þ1.7], P ¼ .173). Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency. Hepcidin levels remained significantly higher during the observation period in the intervention group. Inflammatory biomarkers, red blood cells transfusion rate and hospital duration of stay were similar between groups. Conclusion: Intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.

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“…Chandra et al (2013),Sanderson et al (2011),Mohn et al (2011), andVarpe et al (2009) all published cohort studies on the efficacy of inpatient heparin VTE prophylaxis following colorectal procedures, with all reporting low VTE rates in these patients with a range between 0.6(Varpe et al 2009) and 1.35%(Mohn et al 2011). While these papers were comparable not only in their population (colorectal cancer patients) and length of follow-up (1 to 3 months), all were limited by a small sample size.KlimowiczWhite et al (2015),Sun et al (2015),Jeong et al (2010), andBeyer et al (2009) also all included a cohort of patients receiving inpatient heparin, with comparisons made to mechanical prophylaxis and no prophylaxis, as well as comparison to therapeutic enoxaparin inSchmitges et al (2012) and warfarin anticoagulation bySun et al (2015).…”

mentioning

confidence: 99%

Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety

et al. 2020

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Background:Patients undergoing open abdominopelvic procedures for malignancy are at high risk of postoperative venous thromboembolism (VTE). This risk can be mitigated with prophylaxis; however, optimum duration in this population remains unknown. Our objective was to conduct a systematic review of contemporary literature on the use of heparin thromboprophylaxis following major open pelvic surgery for malignancy, comparing the efficacy and safety of extended duration to inpatient treatment. Methods: A study protocol describing search strategy and inclusion and exclusion criteria was developed and registered with PROSPERO. A literature review was conducted in accordance with the protocol. Results: Literature review identified only 4 studies directly comparing extended and inpatient duration prophylaxis, with a combined population of 3198 and 3135 patients for VTE rate and bleeding events, respectively. Despite many studies reporting lower VTE rates in patients receiving extended prophylaxis, no statistically significant difference in rates of postoperative VTE (p = 0.18) or bleeding complications (p = 0.43) was identified between patients receiving extended duration prophylaxis and those receiving inpatient only prophylaxis. Conclusion: On the review of contemporary literature, no significant difference was found in rates of postoperative VTE or bleeding complications between patients receiving extended duration heparin VTE prophylaxis and those receiving inpatient prophylaxis after open abdominopelvic surgery for malignancy. This raises the question of how extended duration prophylaxis has become common practice in this population, and whether this needs to be re-evaluated.

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Readmission rates due to venous thromboembolism in cancer patients after abdominopelvic surgery, a retrospective chart review

Abstract: Our study showed only one new, symptomatic VTE in the study population, despite 95 % of patients not receiving outpatient anticoagulation, which suggests that continued larger and multicenter trials may be needed to study anticoagulation benefits and risks in this patient population.

Cited by 7 publications

References 19 publications

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Incidence of delayed venous thromboembolic events in patients undergoing abdominal and pelvic surgery for cancer: a systematic review and meta‐analysis

Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels—a randomized controlled trial

Extended versus inpatient thromboprophylaxis with heparins following major open abdominopelvic surgery for malignancy: a systematic review of efficacy and safety

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