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Original Investigation |

Venous Thromboembolism After Major Cancer Surgery:  Temporal Trends and Patterns of Care

Vincent Q. Trinh, BSc1; Pierre I. Karakiewicz, MD1; Jesse Sammon, DO2; Maxine Sun, BSc1; Shyam Sukumar, MD2; Mai-Kim Gervais, MD3; Shahrokh F. Shariat, MD4; Zhe Tian, BSc1; Simon P. Kim, MD5; Keith J. Kowalczyk, MD6; Jim C. Hu, MD7; Mani Menon, MD2; Quoc-Dien Trinh, MD8
[+] Author Affiliations
1Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
2VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
3Division of General Surgery, University of Montreal Health Center, Montreal, Quebec, Canada
4Department of Urology, Weill Medical College of Cornell University, New York, New York
5Department of Urology, Yale School of Medicine, New Haven, Connecticut
6Department of Urology, Georgetown University Hospital, Washington, DC
7Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
8Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2014;149(1):43-49. doi:10.1001/jamasurg.2013.3172.
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Published online

Importance  There is limited data on the prevalence and mortality of venous thromboembolism (VTE) following oncologic surgery.

Objective  To evaluate the trends, factors, and mortality of VTE following major cancer surgery.

Design, Setting, and Participants  Patients undergoing colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy, or prostatectomy were identified retrospectively using the Nationwide Inpatient Sample between January 1, 1999, and December 30, 2009, resulting in a weighted estimate of 2 508 916 patients.

Main Outcomes and Measures  Venous thromboembolism following major cancer surgery was assessed according to date, patient, and hospital characteristics. The determinants of in-hospital VTE were evaluated using logistic regression analysis.

Results  Venous thromboembolism showed an estimated annual percentage increase of 4.0% (95% CI, 2.9% to 5.1%), which contrasts with a 2.4% (95% CI, –4.3% to –0.5%) annual decrease in mortality in VTE after major cancer surgery. In multivariate logistic regression analysis, older age (odds ratio [OR], 1.03; P < .001), female sex (OR, 1.25; P < .001), black race (vs white; OR, 1.56; P < .001), Charlson comorbidity index score of 3 or more (OR, 1.85; P < .001), and Medicaid (vs private insurance; OR, 2.04; P < .001), Medicare (OR, 1.39; P < .001), and uninsured (OR, 1.49; P < .001) status were associated with an increased risk of VTE. Conversely, other (nonwhite and nonblack) race (OR, 0.75; P < .001) was associated with a lower risk of VTE. Among hospital characteristics, urban location (OR, 1.32; P < .001) and teaching status (OR, 1.08; P = .01) were associated with greater odds of VTE. Patients with vs without VTE experienced 5.3-fold greater odds of mortality.

Conclusions and Relevance  During our study period, VTE events following major cancer surgery increased in frequency; however, associated VTE mortality decreased. Changing VTE detection guidelines and better management of this condition may explain our findings.

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Figure.
Rates of VTE and Mortality With VTE in Patients Undergoing MCS Between January 1, 1999, and December 30, 2009, in the United States

EAPC indicates estimated annual percentage change; MCS, major cancer surgery; VTE, venous thromboembolism.

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