title: Post-discharge venous thromboembolism after cancer surgery: extending the case for extended prophylaxis.
abstract: OBJECTIVE
  To (1) define the frequency of overall and postdischarge venous thromboembolism (VTE) after cancer surgery, (2) identify VTE risk for individual cancer operations, and (3) assess mortality rates in patients who experienced a VTE.
  
  
  BACKGROUND
  Cancer is a known risk factor for VTE but less is known about VTE risk after specific cancer operations. Moreover, most cancer patients routinely receive VTE prophylaxis postoperatively while in the hospital, but few receive prolonged prophylaxis despite strong evidence it reduces postdischarge events.
  
  
  METHODS
  From 211 ACS NSQIP hospitals, 44,656 patients undergoing surgery for 9 cancers were identified (2006-2008). The frequency of VTE within 30-days of surgery was evaluated by cancer site and categorized as occurring before or after discharge. Multivariable logistic regression models were constructed to assess risk factors associated with VTE.
  
  
  RESULTS
  VTE occurred in 1.6% of all patients, most frequently after esophagogastric (4.2%) and hepatopancreaticobiliary (3.6%) surgery. Overall, 33.4% of VTEs occurred postdischarge (from 17.9% for esophagogastric to 100% for endocrine operations). Factors associated with VTE were age (≥65 years), cancer/procedure type, metastatic disease, congestive heart failure, body mass index (BMI; ≥25 kg/m(2)), ascites, thrombocytosis (>400,000 cells/mm(3)), albumin (<3.0 g/dL), and operation duration (>2 hours; all P < 0.001). Overall VTE was significantly more likely after gastrointestinal, lung, prostate, and ovarian/uterine operations (all P < 0.001). In those experiencing a VTE, mortality increased over 6-fold (8.0% vs. 1.3%; P < 0.001).
  
  
  CONCLUSIONS
  One-third of VTE events in cancer surgery patients occurred postdischarge. Postoperative VTE was associated with operation type. Routine postdischarge VTE prophylaxis should be considered for high-risk patients.
authors.affiliation: Department of Surgery, Jesse Brown VAMC, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. R-Merkow@northwestern.edu
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Merkow
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Martin D
authors.initials: MD
authors.lastname: McCarter
authors.forename: Mark E
authors.initials: ME
authors.lastname: Cohen
authors.forename: Carlton C
authors.initials: CC
authors.lastname: Barnett
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Caprini
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D010351:Patient Discharge; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000401:mortality