title: Adherence with postdischarge venous thromboembolism chemoprophylaxis recommendations after colorectal cancer surgery among elderly Medicare beneficiaries.
abstract: OBJECTIVE
  To assess national adherence with extended venous thromboembolism (VTE) chemoprophylaxis guideline recommendations after colorectal cancer surgery.
  
  
  BACKGROUND
  Postoperative VTE remains a major cause of morbidity and mortality after abdominal cancer surgery. On the basis of the results from randomized controlled trials, since 2007, national guidelines have suggested that these patients be discharged on VTE chemoprophylaxis.
  
  
  METHODS
  Medicare beneficiaries undergoing open colorectal cancer resections in 2008-2009 were identified using the Medicare Provider Analysis and Review data and limited to those who were enrolled and used Part D for their postoperative prescriptions. Postdischarge use of low-molecular-weight-heparin and other anticoagulants was assessed.
  
  
  RESULTS
  A total of 5078 patients underwent open colorectal cancer surgery and met the inclusion criteria. Of these, 77% underwent colectomy and 23% underwent proctectomy. A prescription for an anticoagulant was filled immediately after discharge for 77 (1.5%) patients, and a low-molecular-weight-heparin for 60 (1.2%) patients. On multivariable analysis, patients were more likely to receive postdischarge VTE chemoprophylaxis if undergoing rectal cancer surgery [incidence rate ratio (IRR), 1.83; 95% confidence interval, 1.07-3.12; vs colon], if higher educational status (IRR, 2.20; 95% confidence interval, 1.23-3.95; vs low education), or if they had a higher Elixhauser comorbidity index (IRR, 1.13; 95% confidence interval, 1.01-1.25; vs lower index).
  
  
  CONCLUSIONS
  Although VTE remains a major issue after abdominal cancer surgery, only 1.5% of Medicare beneficiaries undergoing colorectal cancer surgery received care consistent with established guidelines for postdischarge VTE chemoprophylaxis. Barriers to adherence must be elucidated to improve the quality of care for abdominal and pelvic cancer surgery patients.
authors.affiliation: *Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, the Surgical Outcomes and Quality Improvement Center (SOQIC) and the Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL †Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL ‡Center for Management of Complex Chronic Care, Hines VA Hospitals, Hines, IL; and §Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Merkow
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: Min-Woong
authors.initials: MW
authors.lastname: Sohn
authors.forename: Elissa H
authors.initials: EH
authors.lastname: Oh
authors.forename: Morgan M
authors.initials: MM
authors.lastname: Sellers
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Paruch
authors.forename: Jeanette W
authors.initials: JW
authors.lastname: Chung
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018890:Chemoprevention / Q000379:methods / Q000592:standards*; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D006278:Medicare; D010349:Patient Compliance; D010351:Patient Discharge; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*