"Although the majority of complications occur within 30 days, this is an arbitrarily chosen cutoff," Dr. Syed Nabeel Zafar of the University of Wisconsin School of Medicine and Public Health and colleagues write in JAMA Surgery. "There are no data to suggest a sudden decline in VTE risk at the 30-day mark."
"We demonstrate that the risk is different depending on procedure performed, and... that this risk extends beyond the 30 days ... for several surgery subtypes," Dr. Zafar told Reuters Health by email.
"While the proportion of patients having a clinical relevant VTE event is overall small, the consequences are high," he said. "The burden of readmissions due to VTE is high in terms of patient morbidity, days in the hospital, and also cost to the health care system."
"We as clinicians should be aware that the consequences of VTE after complex cancer surgery are high, and that this risk extends for several weeks and months beyond the surgery, much more than 30 days, as previously thought," he added. "We need better ways to identify patients at higher risk for VTE and implement strategies to prevent its occurrence."
As reported in JAMA Surgery, Dr. Zafar and colleagues analyzed data from 126,104 patients (mean age, 65; 59%, men) in the U.S. 2016 Nationwide Readmissions Database who were readmitted with VTE up to 180 days after complex cancer surgery - e.g., cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy, or hysterectomy.
VTE-associated readmission rates were 0.6% at 30 days; 1.1% at 90 days; and 1.7% at 180-days.
Among patients readmitted for VTE within 90 days, 34.3% went to a different hospital from the index surgery hospital, and 9.2% died. The median length of stay was five days and median cost was $8,102.
The risk of VTE-related readmission varied by procedure and was not constant during the postoperative period. Some procedures, such as pancreatectomy, showed a progressive increase in VTE-related readmission over the course of 180 days; others, such as prostatectomy, plateaued by 60 days.
Independent factors associated with readmission included type of operation; scores for severity (ORs, 1.60-3.54); risk of mortality (ORs, 2.12-3.10); age between 75 and 84 (odds ratio, 1.30); female sex (OR, 1.23); nonelective index admission (OR, 1.31); more comorbidities (OR, 1.30); and experiencing a major postoperative complication during the index admission (OR, 2.08).
The authors conclude, "Quality improvement efforts to decrease the burden of VTE in postoperative patients should measure and account for these late VTE-related readmissions."
Dr. Caron Rockman, Vice-Chief of Vascular Surgery at NYU Langone Health in New York City, commented on the study in an email to Reuters Health. "It is currently recommended that patients who undergo these types of complex cancer operations be maintained on anticoagulation to prevent venous thromboembolic disease during their initial hospitalization and for at least several weeks or months following discharge, providing there are no contraindications to doing so."
"In selected patients who are felt to be at continued increased risk for later venous thromboembolic complications based upon their oncologic profile and medical comorbidities, clinicians should consider an even longer course of anticoagulation up to six months following surgery, and possibly indefinitely in some cases," she said.
"Unfortunately," she noted, "in this study, it is not reported whether the patients who were readmitted for venous thromboembolic disease had been maintained on anticoagulation medications."
SOURCE: https://bit.ly/3oo4CSC JAMA Surgery, online January 26, 2022.
By Marilynn Larkin
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