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. 2015 Aug;150(8):712-20.
doi: 10.1001/jamasurg.2015.1057.

Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery

Colorectal Writing Group for Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative; Daniel W Nelson  1 , Vlad V Simianu  2 , Amir L Bastawrous  3 , Richard P Billingham  2 , Alessandro Fichera  2 , Michael G Florence  3 , Eric K Johnson  1 , Morris G Johnson  4 , Richard C Thirlby  5 , David R Flum  2 , Scott R Steele  1
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Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery

Colorectal Writing Group for Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative et al. JAMA Surg. 2015 Aug.

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 the Washington State Surgical Care and Outcomes Assessment Program (SCOAP) linked to a statewide hospital discharge database. At 52 Washington 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 low and largely unchanged despite increases in perioperative and postoperative prophylaxis. These data should be considered in developing future guidelines.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure
Figure. Trends in the Use of Venous Thromboembolism Prophylaxis by Perioperative Setting and Annual Incidence of 90-Day VTE
Denominators vary for each group. VTE indicates venous thromboembolism.
See this image and copyright information in PMC

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