Timing and Perioperative Risk Factors for In-Hospital and Post-Discharge Venous Thromboembolism After Colorectal Cancer Resection

Davenport, Daniel L.; Vargas, H. David; Kasten, Michael W.; Xenos, Eleftherios S.

doi:10.1177/1076029611433642

Cited by 51 publications

(41 citation statements)

References 31 publications

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“…Only few studies have examined the effect of extended thromboprophylaxis. In a series following patients undergoing major surgery, between 2–5% of patients experienced a VTE within 30 days of discharge suggesting there may be benefit to extended prophylaxis 32, 33 . In contrast, Fanikos et al .…”

Section: Discussionmentioning

confidence: 99%

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Ananthakrishnan

Cagan

Gainer

et al. 2014

Clinical Gastroenterology and Hepatology

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Background & Aims Patients with inflammatory bowel diseases (IBD) have increased risk for venous thromboembolism (VTE); those who require hospitalization have particularly high risk. Few hospitalized patients with IBD receive thromboprophylaxis. We analyzed the frequency of VTE following IBD-related hospitalization, risk factors for post-hospitalization VTE, and the efficacy of prophylaxis in preventing post-hospitalization VTE. Methods In a retrospective study, we analyzed data from a multi-institutional cohort of patients with Crohn's disease or ulcerative colitis and at least 1 IBD-related hospitalization. Our primary outcome was a VTE event. All patients contributed person time from the date of the index hospitalization to development of VTE, subsequent hospitalization, or end of follow-up. Our main predictor variable was pharmacologic thromboprophylaxis. Cox proportional hazard models adjusting for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results From a cohort of 2788 patients with at least 1 IBD-related hospitalization, 62 patients developed VTE following discharge (2%). Incidences of VTE at 30, 60, 90, and 180 days after the index hospitalization were 3.7/1000, 4.1/1000, 5.4/1000, and 9.4/1000 person-days respectively. Pharmacologic thromboprophylaxis during the index hospital stay was associated with a significantly lower risk of post-hospitalization VTE (HR, 0.46; 95% CI, 0.22–0.97). Increased numbers of co-morbidities (HR, 1.30; 95% CI, 1.16–1.47) and need for corticosteroids before hospitalization (HR 1.71, 95% CI 1.02 –2.87) were also independently associated with risk of VTE. Length of hospitalization or surgery during index hospitalization was not associated with post-hospitalization VTE. Conclusions Pharmacologic thromboprophylaxis during IBD-related hospitalization is associated with reduced risk of post-hospitalization VTE.

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Section: Discussionmentioning

confidence: 99%

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Ananthakrishnan

Cagan

Gainer

et al. 2014

Clinical Gastroenterology and Hepatology

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“…Some of the reported predictors include low serum albumin level, American Society of Anesthesiologists (ASA) score greater than two, pregnancy, malignancy, diabetes, chronic steroid use, and obesity [1,[6][7][8]. However, the risk of VTE persists after hospital discharge in all patients [1,[9][10][11]. Two recently published studies reported that 30 % of all VTE events occurred after hospital discharge following colorectal surgery [1,10].…”

Section: Introductionmentioning

confidence: 99%

“…However, the risk of VTE persists after hospital discharge in all patients [1,[9][10][11]. Two recently published studies reported that 30 % of all VTE events occurred after hospital discharge following colorectal surgery [1,10]. Our previously published article showed that 34.6 % of patients with PE and 29.3 % of patients with DVT after colorectal surgery will be diagnosed after discharge [1].…”

Section: Introductionmentioning

confidence: 99%

Post‐Hospital Discharge Venous Thromboembolism in Colorectal Surgery

et al. 2016

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Background There are limited data regarding the criteria for prophylactic treatment of venous thromboembolism (VTE) after hospital discharge. We sought to identify risk factors of post-hospital discharge VTE events following colorectal surgery.Methods The NSQIP database was utilized to examine patients developed VTE after hospital discharge following colorectal surgery during [2005][2006][2007][2008][2009][2010][2011][2012][2013]. Multivariate analysis using logistic regression was performed to quantify risk factors of VTE after discharge.Results We evaluated a total of 219,477 patients underwent colorectal resections. The overall incidence of VTE was 2.1 % (4556). 33.8 % (1541) of all VTE events occurred after hospital discharge. The length of postoperative hospitalization had a strong association with post-discharge VTE, with the highest risk in patients who were hospitalized for more than 1 week after operation (AOR 9.08, P\0.01). Other factors associated with post-discharge VTE included chronic steroid use (AOR 1.81, P\0.01), stage 4 colorectal cancer (AOR 1.40, P = 0.03), obesity (AOR 1.37, P\0.01), age[70 (AOR 1.21, P = 0.04), and open surgery (AOR 1.36, P\0.01). Patients who were hospitalized for more than 1 week after an open colorectal resections had a 12 times higher risk of post-discharge VTE event compared to patients hospitalized less than 4 days after a laparoscopic resection (AOR 12.34, P\0.01).Conclusions VTE is uncommon following colorectal resections; however, a significant proportion occurs after patients are discharged from the hospital (33.8 %). The length of postoperative hospitalization appears to have a strong association with post-discharge VTE. High-risk patients may benefit from continued VTE prophylaxis after discharge.

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“…19,27,28 Although our results did not entirely corroborate this, much of the literature suggests that the proinflammatory state of IBD is prothrombotic. 17,18,29,30 Although infection has previously been identified as a risk factor for VTE in medical patients, 31,32 there is a paucity of data available on the temporal relationship between VTE and infection in surgical patients. What information is available indicates that infection frequently precedes VTE; however, the quantification of this finding had not been explored.…”

Section: Discussionmentioning

confidence: 99%

Infection and Venous Thromboembolism in Patients Undergoing Colorectal Surgery

Monn

Hui

Lau

et al. 2014

Diseases of the Colon &Amp; Rectum

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BACKGROUND There is evidence demonstrating an association between infection and venous thromboembolism. We recently identified this association in the postoperative setting; however, the temporal relationship between infection and venous thromboembolism is not well defined OBJECTIVE We sought to determine the temporal relationship between venous thromboembolism and postoperative infectious complications in patients undergoing colorectal surgery. DESIGN, SETTING, AND PATIENTS A retrospective cohort analysis was performed using data for patients undergoing colorectal surgery in the National Surgical Quality Improvement Project 2010 database. MAIN OUTCOME MEASURES The primary outcome measures were the rate and timing of venous thromboembolism and postoperative infection among patients undergoing colorectal surgery during 30 postoperative days. RESULTS Of 39,831 patients who underwent colorectal surgery, the overall rate of venous thromboembolism was 2.4% (n = 948); 729 (1.8%) patients were diagnosed with deep vein thrombosis, and 307 (0.77%) patients were diagnosed with pulmonary embolism. Eighty-eight (0.22%) patients were reported as developing both deep vein thrombosis and pulmonary embolism. Following colorectal surgery, the development of a urinary tract infection, pneumonia, organ space surgical site infection, or deep surgical site infection was associated with a significantly increased risk for venous thromboembolism. The majority (52%–85%) of venous thromboembolisms in this population occurred the same day or a median of 3.5 to 8 days following the diagnosis of infection. The approximate relative risk for developing any venous thromboembolism increased each day following the development of each type of infection (range, 0.40%–1.0%) in comparison with patients not developing an infection. LIMITATIONS We are unable to account for differences in data collection, prophylaxis, and venous thromboembolism surveillance between hospitals in the database. Additionally, there is limited patient follow-up. CONCLUSIONS These findings of a temporal association between infection and venous thromboembolism suggest a potential early indicator for using certain postoperative infectious complications as clinical warning signs that a patient is more likely to develop venous thromboembolism. Further studies into best practices for prevention are warranted.

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Timing and Perioperative Risk Factors for In-Hospital and Post-Discharge Venous Thromboembolism After Colorectal Cancer Resection

Cited by 51 publications

References 31 publications

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Thromboprophylaxis Is Associated With Reduced Post-hospitalization Venous Thromboembolic Events in Patients With Inflammatory Bowel Diseases

Post‐Hospital Discharge Venous Thromboembolism in Colorectal Surgery

Infection and Venous Thromboembolism in Patients Undergoing Colorectal Surgery

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