The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery.
The aim of this study was to examine the incidence and factors associated with occurrence of venous thromboembolism (VTE) in patients undergoing major gastrointestinal (GI) surgery for malignancy.



The American College of Surgeon's National Surgical Quality Improvement Program, Participant User File database was queried from 2005 to 2012 to study major GI operations performed for cancer. Predictors of VTE and their relation to survival were studied.



In 79,300 patients, the incidence of deep venous thrombosis was 1.7%, and pulmonary embolism was 0.9% during the 30-d postoperative period. The highest rate of VTE occurred after esophagectomy (5.9%) followed by pancreatectomy (3.2%), hepatectomy (3.2%), gastrectomy (2.5%), enterectomy (2.3%), colectomy, and proctectomy (2.0%). On multivariate analysis, disseminated cancer, age ≥ 80 y, body mass index > 35 kg/m(2), functional status, post operative sepsis, pulmonary dysfunction, and longer operative time were associated with occurrence of VTE. Occurrence of VTE was associated with mortality on multivariate analysis (odds ratio 2.4, 95% confidence interval 2.0-3.0, P < 0.001).



Absolute incidence of VTE after major GI surgery is low but is associated with significant mortality and postoperative complications. Disseminated cancer, post operative sepsis, longer operative time, and increased body mass index >35 kg/m(2) further increased the risk of VTE in patients undergoing surgery for malignancy. Surveillance strategies should be implemented for those cancer patients who have multiple risk factors for VTE.
Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York. Electronic address: geoff.bellini@gmail.com.
Geoffrey
G
Bellini
Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
Annabelle
A
Teng
Department of Critical Care, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
Nisha
N
Kotecha
Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
Elie
E
Sutton
Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
Chun Kevin
CK
Yang
Department of Surgery, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
Michael
M
Passeri
Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California.
David Y
DY
Lee
Department of Critical Care, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
Keith
K
Rose
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*
ACS-NSQIP; Gastrointestinal; Malignancy; VTE; Venous thromboembolism