title: Venous thromboembolism after major cancer surgery: temporal trends and patterns of care.
abstract: OBJECTIVE
  There is limited data on the prevalence and mortality of venous thromboembolism (VTE) following oncologic surgery.
  
  
  OBJECTIVE
  To evaluate the trends, factors, and mortality of VTE following major cancer surgery.
  
  
  METHODS
  Patients undergoing colectomy, cystectomy, esophagectomy, gastrectomy, hysterectomy, lung resection, pancreatectomy, or prostatectomy were identified retrospectively using the Nationwide Inpatient Sample between January 1, 1999, and December 30, 2009, resulting in a weighted estimate of 2,508,916 patients.
  
  
  METHODS
  Venous thromboembolism following major cancer surgery was assessed according to date, patient, and hospital characteristics. The determinants of in-hospital VTE were evaluated using logistic regression analysis.
  
  
  RESULTS
  Venous thromboembolism showed an estimated annual percentage increase of 4.0% (95% CI, 2.9% to 5.1%), which contrasts with a 2.4% (95% CI, -4.3% to -0.5%) annual decrease in mortality in VTE after major cancer surgery. In multivariate logistic regression analysis, older age (odds ratio [OR], 1.03; P < .001), female sex (OR, 1.25; P < .001), black race (vs white; OR, 1.56; P < .001), Charlson comorbidity index score of 3 or more (OR, 1.85; P < .001), and Medicaid (vs private insurance; OR, 2.04; P < .001), Medicare (OR, 1.39; P < .001), and uninsured (OR, 1.49; P < .001) status were associated with an increased risk of VTE. Conversely, other (nonwhite and nonblack) race (OR, 0.75; P < .001) was associated with a lower risk of VTE. Among hospital characteristics, urban location (OR, 1.32; P < .001) and teaching status (OR, 1.08; P = .01) were associated with greater odds of VTE. Patients with vs without VTE experienced 5.3-fold greater odds of mortality.
  
  
  CONCLUSIONS
  During our study period, VTE events following major cancer surgery increased in frequency; however, associated VTE mortality decreased. Changing VTE detection guidelines and better management of this condition may explain our findings.
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Vincent Q
authors.initials: VQ
authors.lastname: Trinh
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan.
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan.
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.affiliation: Division of General Surgery, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Mai-Kim
authors.initials: MK
authors.lastname: Gervais
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Tian
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Urology, Georgetown University Hospital, Washington, DC.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Kowalczyk
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*