Thromboembolic complications and prophylaxis patterns in colorectal surgery

Daniel W. Nelson, Vlad V. Simianu, Amir L. Bastawrous, Richard P. Billingham, Alessandro Fichera, Michael G. Florence, Eric K. Johnson, Morris G. Johnson, Richard C. Thirlby, David R. Flum, Scott R. Steele

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

IMPORTANCE Venous thromboembolism (VTE) is an important complication of colorectal surgery, but its incidence is unclear in the era of VTE prophylaxis. OBJECTIVE To describe the incidence of and risk factors associated with thromboembolic complications and contemporary VTE prophylaxis patterns following colorectal surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective data from theWashington State Surgical Care and Outcomes Assessment Program (SCOAP) linked to a statewide hospital discharge database. At 52Washington State SCOAP hospitals, participants included consecutive patients undergoing colorectal surgery between January 1, 2006, and December 31, 2011. MAIN OUTCOMES AND MEASURES Venous thromboembolism complications in-hospital and up to 90 days after surgery. RESULTS Among 16 120 patients (mean age, 61.4 years; 54.5%female), the use of perioperative and in-hospital VTE chemoprophylaxis increased significantly from 31.6%to 86.4%and from 59.6%to 91.4%, respectively, by 2011 (P <.001 for trend for both). Overall, 10.6%(1399 of 13 230) were discharged on a chemoprophylaxis regimen. The incidence of VTE was 2.2%(360 of 16 120). Patients undergoing abdominal operations had higher rates of 90-day VTE compared with patients having pelvic operations (2.5%[246 of 9702] vs 1.8% [114 of 6413], P =.001). Those having an operation for cancer had a similar incidence of 90-day VTE compared with those having an operation for nonmalignant processes (2.1% [128 of 6213] vs 2.3%[232 of 9902], P =.24). On adjusted analysis, older age, nonelective surgery, history of VTE, and operations for inflammatory disease were associated with increased risk of 90-day VTE (P <.05 for all). There was no significant decrease in VTE over time. CONCLUSIONS AND RELEVANCE Venous thromboembolism rates are lowand largely unchanged despite increases in perioperative and postoperative prophylaxis. These data should be considered in developing future guidelines.

Original languageEnglish (US)
Pages (from-to)712-720
Number of pages9
JournalJAMA Surgery
Volume150
Issue number8
DOIs
StatePublished - Aug 1 2015

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© 2015 American Medical Association. All rights reserved.

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