Pre-Operative, Intra-Operative, and Post-Operative Factors Associated with Post-Discharge Venous Thromboembolism Following Colorectal Cancer Resection. 2020

Cary Jo R Schlick, and Jessica Y Liu, and Anthony D Yang, and David J Bentrem, and Karl Y Bilimoria, and Ryan P Merkow
Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

Venous thromboembolism (VTE) is the most common preventable cause of 30-day post-operative mortality, with many events occurring after hospital discharge. High-level evidence supports post-discharge VTE chemoprophylaxis following abdominal/pelvic cancer resection; however, some studies support a more tailored approach. Our objectives were to (1) identify risk factors associated with post-discharge VTE in a large cohort of patients undergoing colorectal cancer resection and (2) develop a post-discharge VTE risk calculator. Patients who underwent colorectal cancer resection from 2012 to 2016 were identified from ACS NSQIP colectomy and proctectomy procedure-targeted modules. Multivariable logistic regression was used to identify factors associated with post-discharge VTE. Incorporating pre-operative, intra-operative, and post-operative variables, a post-discharge VTE risk calculator was constructed and validated. Of 51,139 patients, 387 (0.76%) developed post-discharge VTE. Pre-operative factors associated with post-discharge VTE included BMI (e.g., morbidly obese OR 2.27, 95% CI 1.65-3.12 vs. normal BMI), and thrombocytosis (OR 1.41, 95% CI 1.03-1.92). Intra-operative factors included operative time (4-6 h OR 1.56, 95% CI 1.12-2.17; > 6 h, OR 1.85, 95% CI 1.21-2.84, vs. < 2 h), and type of operation (e.g., open partial colectomy OR 1.67, 95% CI 1.30-2.16 vs. laparoscopic partial colectomy). Post-operative factors included anastomotic leak (OR 2.05, 95% CI 1.31-3.21) and post-operative ileus (OR 1.39, 95% CI 1.07-1.79). Using the risk calculator, the predicted probability of post-discharge VTE ranged from 0.04 to 10.29%. On a 10-fold cross validation, the calculator's mean C-Statistic was 0.65. Patient-specific factors are associated with varying rates of post-discharge VTE. We present the first post-discharge VTE risk calculator designed for use at the time of discharge following colorectal cancer resection.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D010351 Patient Discharge The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities. Discharge Planning,Discharge Plannings,Discharge, Patient,Discharges, Patient,Patient Discharges,Planning, Discharge,Plannings, Discharge
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D012042 Registries The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers. Parish Registers,Population Register,Parish Register,Population Registers,Register, Parish,Register, Population,Registers, Parish,Registers, Population,Registry
D003082 Colectomy Surgical resection of a portion of or the entire colon. Hemicolectomy,Large Bowel Resection,Colectomies,Hemicolectomies,Large Bowel Resections,Resection, Large Bowel,Resections, Large Bowel
D005260 Female Females
D006305 Health Status Indicators The measurement of the health status for a given population using a variety of indices, including morbidity, mortality, and available health resources. Health Risk Appraisal,Health Status Index,Health Status Indexes,Appraisal, Health Risk,Appraisals, Health Risk,Health Risk Appraisals,Health Status Indicator,Health Status Indices,Index, Health Status,Indexes, Health Status,Indicator, Health Status,Indicators, Health Status,Indices, Health Status,Risk Appraisal, Health,Risk Appraisals, Health
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000078542 Proctectomy Surgical resection of the RECTUM. Abdomino-Perineal Rectum Excision,Abdomino-Perineal Resection,Abdomino-perineal Excision,Abdominoperineal Excision,Abdominoperineal Rectum Excision,Abdominoperineal Resection,Rectum Excision,Rectum Resection,Abdomino Perineal Rectum Excision,Abdomino Perineal Resection,Abdomino perineal Excision,Abdomino-Perineal Rectum Excisions,Abdomino-Perineal Resections,Abdomino-perineal Excisions,Abdominoperineal Excisions,Abdominoperineal Rectum Excisions,Abdominoperineal Resections,Excision, Abdomino-Perineal Rectum,Excision, Abdomino-perineal,Excision, Abdominoperineal,Excision, Abdominoperineal Rectum,Excision, Rectum,Excisions, Abdomino-Perineal Rectum,Proctectomies,Rectum Excision, Abdomino-Perineal,Rectum Excision, Abdominoperineal,Rectum Excisions,Rectum Resections,Resection, Abdomino-Perineal,Resection, Abdominoperineal,Resection, Rectum,Resections, Abdominoperineal

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