Hospital readmissions related to venous thromboembolism (VTE) may occur up to 180 days after complex cancer surgery, according to research published in JAMA Surgery.

Researchers noted that roughly 2% of patients who undergo complex cancer surgery develop VTE, and up to 50% of postoperative deaths are attributed to VTE. However, the incidence of VTE-related readmissions beyond 30 days after surgery has not been well studied.

With that in mind, the researchers analyzed data from 197,510 visits by 126,104 patients who underwent complex cancer surgery between January 1, 2016, and September 30, 2016.


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The surgeries included esophagectomy, gastrectomy, colectomy, proctectomy, pancreatectomy, prostatectomy, hysterectomy, cystectomy, liver/biliary tree resection, or lung/bronchus resection for a corresponding cancer diagnosis.

For the primary hospital admission, the median length of stay was 4 days (interquartile range [IQR], 2-8 days), 17.9% of patients developed at least 1 major complication, and the in-hospital mortality rate was 1.15%.

Of the 126,104 patients, 124,644 were discharged alive and without a diagnosis of VTE. The proportion of patients who were readmitted due to VTE was 0.6% within 30 days of discharge and 1.1% within 90 days. VTE was the primary cause for 5.8% of readmissions that occurred within 90 days.

For the patients who were readmitted due to VTE within 90 days, the median length of stay was 5 days (IQR, 3-7 days), the in-hospital mortality rate was 9.2%, and 6.2% of patients were readmitted multiple times.

The researchers also examined VTE-related readmissions within 180 days in 83,337 patients who underwent surgery between January 1, 2016, and June 30, 2016, and survived until discharge. In this group, the rate of VTE-related readmission was 1.7%.

Lastly, the researchers performed a multivariate analysis to identify factors associated with an increased risk of VTE-related readmission within 90 days.

They found the type of surgery was significantly associated with readmission, and 90-day VTE-related readmissions were most common after cystectomy (odds ratio [OR], 2.57; 95% CI, 2.20-2.98), pancreatectomy (OR, 1.88; 95% CI, 1.57-2.23), and esophagectomy (OR, 1.45; 95% CI, 1.10-1.87).

Additional factors significantly associated with an increased risk of 90-day VTE-related readmission included moderate to extreme scores for severity of illness and risk of mortality, age 75 to 84 years (vs 18 to 44 years), female sex, non-elective index admission, higher number of comorbidities, and a prior major postoperative complication during their primary stay.

There was no association between VTE readmission and adjuvant chemotherapy, and a laparoscopic approach was associated with a lower risk of VTE-related readmission.

“These results suggest that the burden of VTE after complex cancer surgery is underappreciated by registries focused on 30-day outcomes,” the researchers wrote. “Quality improvement efforts on the burden of VTE should ensure a longer follow-up period.”

Reference

Mallick S, Aiken T, Varley P, et al. Readmissions from venous thromboembolism after complex cancer surgery. JAMA Surg. Published online January 26, 2022. doi:10.1001/jamasurg.2021.7126