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

Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery.

Author information

1
Madigan Army Medical Center, Department of Surgery, Fort Lewis, Washington.
2
University of Washington, Department of Surgery, Seattle.
3
Swedish Medical Center, Department of Surgery, Seattle, Washington.
4
Skagit Valley Medical Center, Department of Surgery, Mount Vernon, Washington.
5
Virginia Mason Medical Center, Department of Surgery, Seattle, Washington.

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.

PMID:
26060977
PMCID:
PMC4545402
DOI:
10.1001/jamasurg.2015.1057
[Indexed for MEDLINE]
Free PMC Article

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