This article is more than 5 years old. Information may no longer be current.
VTE rates following colorectal surgery remain stable despite increased prophylaxis
Click Here to Manage Email Alerts
Venous thromboembolism incidence has remained low and largely unchanged following colorectal surgery despite an increase in pre- and post-surgical prevention strategies, according to study results.
VTE is an important complication following colorectal surgery; however, its incidence remained unclear in light of the development of various prophylaxis patterns and guidelines, — such as the American College of Chest Physicians’ guidelines on abdominal surgery and ASCO’s guidelines for VTE prevention in cancer — according to study background.
Scott R. Steele, MD, of the department of surgery at the Madigan Army Medical Center in Tacoma, Washington, and colleagues from the Surgical Care and Outcomes Assessment Program-Comparative Effectiveness Research Translation Network Collaborative evaluated prospective data to measure VTE complications during hospitalization and up to 90 days following colorectal surgery.
The analysis included data from 16,120 consecutive patients (mean age, 61.4 years; 54.5% women) who underwent colorectal cancer surgery at 52 hospitals in Washington State between 2006 and 2011.
The use of perioperative (31.6% to 86.4%) and in-hospital (59.6% to 91.4%) VTE chemoprophylaxis significantly increased from 2006 to 2011 (P < .001 for both).
Overall, 10.6% of patients were discharged following surgery on a chemoprophylaxis regimen. VTE occurred in 2.2% of patients.
A higher rate of 90-day VTE occurred among patients undergoing abdominal operations compared with patients undergoing pelvic operations (2.5% vs. 1.8%; P = .001).
A similar 90-day VTE rate occurred among patients undergoing surgery for cancer compared with those undergoing surgery for non-malignancies (2.1% vs. 2.3%).
Results of adjusted analyses demonstrated an increased risk for 90-day VTE among older patients, patients undergoing nonelective surgery, patients with a history of VTE and patients receiving surgery for inflammatory disease (P ˂ .05 for all).
Researchers observed no significant decrease in VTE incidence over time, and VTE rates remained between 1% and 3% annually.
The researchers acknowledged limitations to their study, including the reliance on proper coding or hospitalization to determine VTE incidence post-discharge. Further, the researchers could not access data regarding the use of anticoagulation.
“With almost 40% of VTE events occurring after discharge, this may represent an area for quality improvement implementation,” the researchers concluded. “However, it must be carefully balanced against the potential for increased complications and higher costs at no additional benefit. These findings should influence further studies looking specifically at extended prophylaxis and prophylaxis guidelines.”
These study findings suggest that VTE rates may represent an inaccurate endpoint for hospital quality measures, Christian de Virgilio, MD, and Jerry J. Kim, MD, both of the department of surgery at the Harbor–University of California, Los Angeles Medical Center in Torrance, California, wrote in an accompanying editorial.
“Linking VTE rates to reimbursement has the potential to negatively influence patient care,” de Virgilio and Kim wrote. “Extended prophylaxis may lead to bleeding complications. Physicians and hospitals may become more reluctant to perform needed imaging procedures when the indications are questionable.” – by Cameron Kelsall
Click Here to Manage Email Alerts