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Results of a large, retrospective study suggest a need for more frequent use of post-discharge thromboprophylaxis in colorectal surgery patients.
Although the overall rate of venous thromboembolism (VTE) in this study was low, nearly 40% of the VTEs occurred after hospital discharge.
And discharge prophylaxis was used in a small percentage of patients. So researchers believe this may be an area for improvement in patient care.
The team described this research in JAMA Surgery alongside a related commentary.
The study was conducted by the Colorectal Writing Group for the Surgical Care and Outcomes Assessment Program-Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative.
The group analyzed data from 16,120 patients who underwent colorectal surgery between 2006 and 2011 at 52 hospitals in Washington. The goal was to determine whether the incidence of VTE had changed with evolving prophylaxis patterns.
The researchers found the use of VTE prophylaxis increased significantly during the study period, but there was no significant change in VTE incidence.
The use of perioperative prophylaxis increased from 31.6% (323/1021) to 86.4% (3007/3480). The use of postoperative, in-hospital prophylaxis increased from 59.6% (603/1012) to 91.4% (3223/3527). And the use of discharge prophylaxis increased from 8.6% to 11.7%. Overall, 10.6% of patients (1399/13,230) were discharged on VTE prophylaxis.
The incidence of any VTE up to 90 days after surgery was 2.2% (360/16,120), and 60.6% of these events (218/360) occurred during a patient’s hospital stay.
The unadjusted, 90-day VTE rate increased during the study period, from 1.2% in 2006 to 3.0% in 2011 (P<0.01 for trend). However, there were no significant differences in VTE incidence over time after the researchers adjusted for patient and operative variables (P=0.09).
The researchers also found that patients who underwent abdominal operations had higher rates of 90-day VTE than patients who had pelvic operations—2.5% vs 1.8%. And patients undergoing cancer-related operations had a similar incidence of VTE as patients having operations not related to malignancy—2.1% vs 2.3%.
These results were surprising because previous research suggested that VTE rates tend to be higher among cancer patients and those who undergo pelvic surgery, said study author Scott R. Steele, MD, of Madigan Army Medical Center in Tacoma, Washington.
Dr Steele also noted that this study suggests a low overall rate of VTE in patients who undergo colorectal surgery, but discharge prophylaxis may be an area for quality improvement. Nearly 40% of VTEs occurred after hospital discharge, and only about 11% of patients received discharge prophylaxis.
Still, he said researchers would need to conduct a large-scale, randomized trial to confirm a benefit for discharge prophylaxis in these patients.
