title: Variation in thromboembolic complications among patients undergoing commonly performed cancer operations.
abstract: OBJECTIVE
  There is widespread evidence that cancer confers an increased risk of deep venous thrombosis (DVT). This risk is thought to vary among different cancer types. The purpose of this study is to better define the incidence of thrombotic complications among patients undergoing surgical treatment for a spectrum of prevalent cancer diagnoses in contemporary practice.
  
  
  METHODS
  All patients undergoing one of 11 cancer surgical operations (breast resection, hysterectomy, prostatectomy, colectomy, gastrectomy, lung resection, hepatectomy, pancreatectomy, cystectomy, esophagectomy, and nephrectomy) were identified by Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes using the American College of Surgeons National Surgical Quality Improvement Program database (2007-2009). The study endpoints were DVT, pulmonary embolism (PE), and overall postoperative venous thromboembolic events (VTE) within 1 month of the index procedure. Multivariate logistic regression was utilized to calculate adjusted odds ratios for each endpoint.
  
  
  RESULTS
  Over the study interval, 43,808 of the selected cancer operations were performed. The incidence of DVT, PE, and total VTE within 1 month following surgery varied widely across a spectrum of cancer diagnoses, ranging from 0.19%, 0.12%, and 0.28% for breast resection to 6.1%, 2.4%, and 7.3%, respectively, for esophagectomy. Compared with breast cancer, the incidence of VTE ranged from a 1.31-fold increase in VTE associated with gastrectomy (95% confidence interval, 0.73-2.37; P = .4) to a 2.68-fold increase associated with hysterectomy (95% confidence interval, 1.43-5.01; P = .002). Multivariate logistic regression revealed that inpatient status, steroid use, advanced age (≥60 years), morbid obesity (body mass index ≥35), blood transfusion, reintubation, cardiac arrest, postoperative infectious complications, and prolonged hospitalization were independently associated with increased risk of VTE.
  
  
  CONCLUSIONS
  The incidence of VTE and thromboembolic complications associated with cancer surgery varies substantially. These findings suggest that both tumor type and resection magnitude may impact VTE risk. Accordingly, such data support diagnosis and procedural-specific guidelines for perioperative VTE prophylaxis and can be used to anticipate the risk of potentially preventable morbidity.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, 3V, Lebanon, NH 03766, USA. randall.r.de.martino@hitchcock.org
authors.forename: Randall R
authors.initials: RR
authors.lastname: De Martino
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Emily L
authors.initials: EL
authors.lastname: Spangler
authors.forename: Jessica B
authors.initials: JB
authors.lastname: Wallaert
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Corriere
authors.forename: Eva M
authors.initials: EM
authors.lastname: Rzucidlo
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
authors.forename: David H
authors.initials: DH
authors.lastname: Stone
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003082:Colectomy / Q000009:adverse effects; D016001:Confidence Intervals; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000009:adverse effects; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D011468:Prostatectomy / Q000009:adverse effects; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology