title: Postdischarge venous thromboembolic complications following pulmonary oncologic resection: An underdetected problem.
abstract: OBJECTIVE
  To determine the prevalence of delayed postoperative venous thromboembolism (VTE) in patients undergoing oncologic lung resections, despite adherence to current in-hospital VTE prophylaxis guidelines.
  
  
  METHODS
  Patients undergoing lung resection for malignancy in 2 tertiary-care centers were recruited between June 2013 and December 2014. All patients received guideline-based VTE prophylaxis until hospital discharge. Patients underwent computed tomography chest angiography with pulmonary embolism (PE) protocol and bilateral lower extremity venous Doppler ultrasonography at 30 ± 5 days after surgery to determine the incidence of postoperative VTE. Univariate analysis was used to compare the VTE and non-VTE groups.
  
  
  RESULTS
  A total of 157 patients were included, 45.9% were men with a mean age of 66.7 years. VTE prevalence was 12.1% with a total of 19 VTE events, including 14 PEs (8.9%), 3 deep venous thromboses (DVTs) (1.9%), 1 combined PE/DVT, and 1 massive left atrial thrombus originating from the pulmonary vein stump after pulmonary lobectomy. PE events occurred in the operated lung 64% of the time and 4 patients (21.1%) were symptomatic at diagnosis. The 30-day mortality rate of VTE events was 5.2%, with 1 patient who died secondary to massive in situ ipsilateral PE following readmission to the hospital. Univariate analysis did not demonstrate significant differences between the VTE and non-VTE populations with regard to baseline characteristics.
  
  
  CONCLUSIONS
  Despite adherence to in-hospital standard prophylaxis guidelines, VTE events are frequent, often asymptomatic, and with associated significant morbidity and mortality. More research into the potential role of predischarge screening and extended prophylaxis is warranted.
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Agzarian
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Waël C
authors.initials: WC
authors.lastname: Hanna
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Schneider
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Colin
authors.initials: C
authors.lastname: Schieman
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Finley
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Yury
authors.initials: Y
authors.lastname: Peysakhovich
authors.affiliation: Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Terri
authors.initials: T
authors.lastname: Schnurr
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Dennis
authors.initials: D
authors.lastname: Nguyen-Do
authors.affiliation: Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Lori-Ann
authors.initials: LA
authors.lastname: Linkins
authors.affiliation: Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Douketis
authors.affiliation: Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Crowther
authors.affiliation: Department of Surgery, University of Toronto, Faculty of Medicine, University Health Network, Toronto, Ontario, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: De Perrot
authors.affiliation: Department of Surgery, University of Toronto, Faculty of Medicine, University Health Network, Toronto, Ontario, Canada.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Waddell
authors.affiliation: Department of Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada. Electronic address: shargal@mcmaster.ca.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shargall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010351:Patient Discharge; D010359:Patient Readmission; D010865:Pilot Projects; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality / Q000592:standards; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D062606:Tertiary Care Centers; D013923:Thromboembolism / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control
chemical_list: D005343:Fibrinolytic Agents
keywords: deep vein thrombosis; lung cancer resection; prevalence; pulmonary embolism; screening