VTE-related hospital readmissions continue to rise months after complex cancer surgery
Click Here to Manage Email Alerts
Venous thromboembolism-related hospital readmissions after complex cancer surgery continued to increase beyond 30 days after surgery, according to a multicenter, population-based retrospective study in JAMA Surgery.
"VTE events, while low in proportion, bear a significant burden to the patient and health care system. These are potentially preventable, and we can do more to prevent them," Syed Nabeel Zafar, MD, MPH, assistant professor in the division of surgical oncology in the department of surgery at University of Wisconsin School of Medicine and Public Health, told Healio.
Background and methodology
VTE, a major cause of preventable morbidity and mortality after cancer surgery, can lead to potentially life-threatening events significant enough to require hospital readmission. Despite this, data has been limited on the frequency of these events beyond the 30-day postoperative period.
The analysis included 197,510 visits among 126,104 adults (mean age, 65 years; standard deviation, 11.5; 58.7% men) who had a complex cancer operation (cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy or hysterectomy) between Jan. 1 to Sept. 30, 2016.
Researchers evaluated the proportion of 30-, 90- and 180-day VTE readmissions after surgery. They also analyzed factors associated with readmissions, as well as outcomes observed during readmission, including mortality, length of stay, hospital cost and readmission to index vs. nonindex hospital.
Key findings
After surgery, 767 patients (0.6%) had been readmitted with a VTE-related diagnosis within 30 days, 1,331 patients (1.1%) within 90 days, and 1,449 of 83,337 patients (1.7%) within 180 days.
Factors associated with readmission included type of operation, scores for severity and risk for mortality, age of 75 to 84 years (OR = 1.3; 95% CI, 1.02-1.78), female sex (OR = 1.23; 95% CI, 1.11-1.37), nonelective index admission (OR = 1.31; 95% CI, 1.03-1.68), higher number of comorbidities (OR = 1.3; 95% CI, 1.06-1.6) and experiencing a major complication after operation during the index admission (OR = 2.08; 95% CI, 1.85-2.33).
“The variation in VTE events by surgical procedure was quite interesting,” Zafar told Healio. “We suspected severe VTE events may continue beyond 30 days of surgery, but as there was not much prior data on this, we were not sure what the numbers would look like.”
Researchers noted that 15.8% of patients who died during their initial readmission had a primary diagnosis of VTE.
Among 1,331 patients readmitted for VTE within 90 days, 456 (34.3%) had been readmitted to a different hospital than the index surgery hospital. Patients had a median length of stay of 5 days (interquartile range [IQR], 3-7 days) at a median cost of $8,102 (IQR, $5,311-$10,982), and 122 (9.2%) died during readmission.
Implications
The results necessitate a longer follow-up period as the burden of VTE after complex cancer surgery is currently “underappreciated by registries focused on 30-day outcomes,” Zafar and colleagues concluded.
"We have all had patients who suffer significant morbidity or even death from VTE during their cancer treatment," Zafar told Healio. “There is a need to identify patients at varying risk for VTE and develop strategies for prevention."
For more information:
Syed Nabeel Zafar MD, MPH, can be reached at Division of Surgical Oncology, Department of Surgery, University of Wisconsin School of Medicine and Public Health Clinical Science Center, 600 Highland Ave., Madison, WI 53792; email: zafars@surgery.wisc.edu.
Collapse
Read more about
Click Here to Manage Email Alerts