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VTE after major cancer surgery varied by race, insurance coverage
Rates of venous thromboembolism following major cancer surgery varied according to patient characteristics and their insurance coverage, study results showed.
The rate of VTE following major cancer surgery increased during the study period but the rate for VTE-associated mortality decreased, a finding researchers attributed to improved detection methods.
Researchers used the Nationwide Inpatient Sample to identify 2.5 million patients who underwent major cancer surgery — including colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy or prostatectomy — between 1999 and 2009.
Researchers found the rate for VTE following major cancer surgery increased 4% (95% CI, 2.9%-5.1%) annually, yet the rate for mortality in VTE after major cancer surgery decreased 2.4% (95% CI, -4.3% to -0.5%) annually.
Mortality from VTE was highest among patients who underwent lung resection (19.8%) and gastrectomy (14.7%), whereas patients who underwent prostatectomy (3.9%) and hysterectomy (5.2%) were at the least risk.
Overall, patients with VTE were at 5.3-fold greater risk for mortality compared with those without VTE.
The risk for VTE was higher in patients who were older (OR=1.03; P˂.001), female (OR=1.25; P˂.001) and those who had a Charlson comorbidity index score of 3 or more (OR=1.85; P˂.001).
Black patients were at increased risk for VTE compared with non-Hispanic white patients (OR=1.56; P˂.001).
Patients who were insured with Medicaid vs. private insurance were at increased risk for VTE (OR=2.04; P˂.001), and patients with Medicare (OR=1.39; P˂.001) or who were uninsured (OR=1.49; P˂.001) also were at increased risk.
When researchers analyzed risk based on hospital characteristics, they found urban location (OR=1.32; P˂.001) and teaching status (OR=1.08; P=.01) were associated with an increased risk for VTE.
“We observe that consistently increasing VTE rates recorded during the past decade are likely due to improved detection methods and evolving guidelines,” the researchers wrote. “Disparities in VTE prevalence and mortality based on race and insurance coverage highlight the need for improved access to quality health care to avoid a potentially devastating outcome due to preventable VTE.”
Disclosure: The researchers report no relevant financial disclosures.