Time trends in the incidence rates of venous thromboembolism following colorectal resection by indication and operative technique

Abstract

Aim It is important for patient safety to assess if international changes in perioperative care, such as the focus on venous thromboembolism (VTE) prevention and minimally invasive surgery, have reduced the high post colectomy VTE risks previously reported. This study assesses the impact of changes in perioperative care on VTE risk following colorectal resection. Method This was a population‐based cohort study of colectomy patients in England between 2000 and 2019 using a national database of linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Within 30 days following colectomy, absolute VTE rates per 1000 person‐years and adjusted incidence rate ratios (aIRRs) using Poisson regression for the per year change in VTE risk were calculated. Results Of 183 791 patients, 1337 (0.73%) developed 30‐day postoperative VTE. Overall, VTE rates reduced over the 20‐year study period following elective (relative risk reduction 31.25%, 95% CI 5.69%–49.88%) but not emergency surgery. Similarly, yearly changes in VTE risk reduced following minimally invasive resections (elective benign, aIRR 0.93, 95% CI 0.90–0.97; elective malignant, aIRR 0.94, 95% CI 0.91–0.98; and emergency benign, aIRR 0.96, 95% CI 0.92–1.00) but not following open resections. There was a per year VTE risk increase following open emergency malignant resections (aIRR 1.02, 95% CI 1.00–1.04). Conclusion Yearly VTE risks reduced following minimally invasive surgeries in the elective setting yet in contrast were static following open elective colectomies, and following emergency malignant resections increased by almost 2% per year. To reduce VTE risk, further efforts are required to implement advances in surgical care for those having emergency and/or open surgery.

Risk of Bleeding and Venous Thromboembolism after Colorectal Cancer Surgery in Patients with and without Type 2 Diabetes: A Danish Cohort Study

“…5,8,9,12,13 Venous thromboembolism (VTE) is a potential fatal periand postoperative outcome, with a 30-day risk of 0.3 to 3.0% despite treatment with thromboprophylaxis. [14][15][16][17][18] Thromboprophylaxis has benefits and drawbacks, in that the risk of VTE must be balanced against the risk of bleeding. 19 However, striking this balance in patients with T2D can be challenging.…”

Venous thromboembolism following colectomy for diverticular disease: an English population-based cohort study

“…Current literature reports patients with diverticular disease and those undergoing colorectal surgery, especially as an emergency procedure are at a greater risk of postoperative venous thromboembolism (VTE) [ 8 – 11 ]. Therefore, VTE rates are expected to be high in this group [ 12 ].…”

Venous Thromboembolism Following Colectomy for Diverticular Disease

“…Current literature reports patients with diverticular disease and those undergoing colorectal surgery, especially as an emergency procedure are at a greater risk of postoperative venous thromboembolism (VTE) [8][9][10][11]. Therefore, VTE rates are expected to be high in this group [12].…”