title: Post-Hospital Discharge Venous Thromboembolism in Colorectal Surgery.
abstract: BACKGROUND
  There are limited data regarding the criteria for prophylactic treatment of venous thromboembolism (VTE) after hospital discharge. We sought to identify risk factors of post-hospital discharge VTE events following colorectal surgery.
  
  
  METHODS
  The NSQIP database was utilized to examine patients developed VTE after hospital discharge following colorectal surgery during 2005-2013. Multivariate analysis using logistic regression was performed to quantify risk factors of VTE after discharge.
  
  
  RESULTS
  We evaluated a total of 219,477 patients underwent colorectal resections. The overall incidence of VTE was 2.1 % (4556). 33.8 % (1541) of all VTE events occurred after hospital discharge. The length of postoperative hospitalization had a strong association with post-discharge VTE, with the highest risk in patients who were hospitalized for more than 1 week after operation (AOR 9.08, P < 0.01). Other factors associated with post-discharge VTE included chronic steroid use (AOR 1.81, P < 0.01), stage 4 colorectal cancer (AOR 1.40, P = 0.03), obesity (AOR 1.37, P < 0.01), age >70 (AOR 1.21, P = 0.04), and open surgery (AOR 1.36, P < 0.01). Patients who were hospitalized for more than 1 week after an open colorectal resections had a 12 times higher risk of post-discharge VTE event compared to patients hospitalized less than 4 days after a laparoscopic resection (AOR 12.34, P < 0.01).
  
  
  CONCLUSIONS
  VTE is uncommon following colorectal resections; however, a significant proportion occurs after patients are discharged from the hospital (33.8 %). The length of postoperative hospitalization appears to have a strong association with post-discharge VTE. High-risk patients may benefit from continued VTE prophylaxis after discharge.
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Zhobin
authors.initials: Z
authors.lastname: Moghadamyeghaneh
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Reza Fazl
authors.initials: RF
authors.lastname: Alizadeh
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Hanna
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Grace
authors.initials: G
authors.lastname: Hwang
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Carmichael
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Mills
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA.
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.affiliation: Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA. mstamos@uci.edu.|John E. Connolly Chair in Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA. mstamos@uci.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
mesh_terms: D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology*