title: Thromboembolic Complications and Prophylaxis Patterns in Colorectal Surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  Venous thromboembolism rates are low and largely unchanged despite increases in perioperative and postoperative prophylaxis. These data should be considered in developing future guidelines.
authors.affiliation: Madigan Army Medical Center, Department of Surgery, Fort Lewis, Washington.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Nelson
authors.affiliation: University of Washington, Department of Surgery, Seattle.
authors.forename: Vlad V
authors.initials: VV
authors.lastname: Simianu
authors.affiliation: Swedish Medical Center, Department of Surgery, Seattle, Washington.
authors.forename: Amir L
authors.initials: AL
authors.lastname: Bastawrous
authors.affiliation: University of Washington, Department of Surgery, Seattle.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Billingham
authors.affiliation: University of Washington, Department of Surgery, Seattle.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fichera
authors.affiliation: Swedish Medical Center, Department of Surgery, Seattle, Washington.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Florence
authors.affiliation: Madigan Army Medical Center, Department of Surgery, Fort Lewis, Washington.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Johnson
authors.affiliation: Skagit Valley Medical Center, Department of Surgery, Mount Vernon, Washington.
authors.forename: Morris G
authors.initials: MG
authors.lastname: Johnson
authors.affiliation: Virginia Mason Medical Center, Department of Surgery, Seattle, Washington.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Thirlby
authors.affiliation: University of Washington, Department of Surgery, Seattle.
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.affiliation: Madigan Army Medical Center, Department of Surgery, Fort Lewis, Washington.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Steele
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D018890:Chemoprevention; D003082:Colectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D003106:Colon / Q000601:surgery; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007410:Intestinal Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D014861:Washington / Q000453:epidemiology
chemical_list: D000925:Anticoagulants