Volume 40, Issue 5 1 pp. 1255-1263

Original Scientific Report

Post-Hospital Discharge Venous Thromboembolism in Colorectal Surgery

Zhobin Moghadamyeghaneh,

Zhobin Moghadamyeghaneh

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Reza Fazl Alizadeh,

Reza Fazl Alizadeh

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Mark H. Hanna,

Mark H. Hanna

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Grace Hwang,

Grace Hwang

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Joseph C. Carmichael,

Joseph C. Carmichael

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Steven Mills,

Steven Mills

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Alessio Pigazzi,

Alessio Pigazzi

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Michael J. Stamos,

Corresponding Author

Michael J. Stamos

[email protected]
(714) 456-6262

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

John E. Connolly Chair in Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, 92868 Orange, CA, USA

Tel.: (714) 456-6262, [email protected]Search for more papers by this author

Zhobin Moghadamyeghaneh,

Zhobin Moghadamyeghaneh

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Reza Fazl Alizadeh,

Reza Fazl Alizadeh

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Mark H. Hanna,

Mark H. Hanna

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Grace Hwang,

Grace Hwang

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Joseph C. Carmichael,

Joseph C. Carmichael

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Steven Mills,

Steven Mills

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Alessio Pigazzi,

Alessio Pigazzi

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

Search for more papers by this author

Michael J. Stamos,

Corresponding Author

Michael J. Stamos

[email protected]
(714) 456-6262

Department of Surgery, University of California, Irvine, School of Medicine, Orange, CA, USA

John E. Connolly Chair in Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, 92868 Orange, CA, USA

Tel.: (714) 456-6262, [email protected]Search for more papers by this author

First published: 11 January 2016

https://doi.org/10.1007/s00268-015-3361-5

Citations: 27

Presented as a poster of distinction presentation: The American Society of Colon and Rectal Surgeons Meeting, Boston, MA, May 30–June 3, 2015.

Share a link

Email
Wechat
Bluesky

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.

References

1MoghadamyeghanehZ, HannaMH, CarmichaelJC, NguyenNT, StamosMJ A nationwide analysis of postoperative deep vein thrombosis and pulmonary embolism in colon and rectal surgery. J Gastrointest Surg (2014) 18(12): 2169–217710.1007/s11605-014-2647-5 25213583
10.1007/s11605-014-2647-5
PubMed Web of Science® Google Scholar
2KesterBS, MerkowRP, JuMH, PeabodyTD, BentremDJ, KoCY et al. Effect of post-discharge venous thromboembolism on hospital quality comparisons following hip and knee arthroplasty. J Bone Joint Surg Am (2014) 96: 1476–148410.2106/JBJS.M.01248 25187587
10.2106/JBJS.M.01248
PubMed Web of Science® Google Scholar
3AndersonFA, ZayaruznyM, HeitJA, FidanD, CohenAT Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol (2007) 82: 777–78210.1002/ajh.20983 17626254
10.1002/ajh.20983
PubMed Web of Science® Google Scholar
4AlikhanR, PetersF, WilmottR, CohenAT Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol (2004) 57: 1254–125710.1136/jcp.2003.013581 15563663
10.1136/jcp.2003.013581
CAS PubMed Web of Science® Google Scholar
5LindbladB, SternbyNH, BergqvistD Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ (1991) 302: 709–71110.1136/bmj.302.6778.709 2021744
10.1136/bmj.302.6778.709
CAS PubMed Web of Science® Google Scholar
6McNallyMP, BurnsCJ Venous thromboembolic disease in colorectal patients. Clin Colon Rectal Surg (2009) 22: 34–4010.1055/s-0029-1202884 20119554
10.1055/s-0029-1202884
PubMed Google Scholar
7WilsonMZ, ConnellyTM, TinsleyA, HollenbeakCS, KoltunWA, MessarisE Ulcerative colitis is associated with an increased risk of venous thromboembolism in the postoperative period: the results of a matched cohort analysis. Ann Surg (2014) 261(6): 1160–116610.1097/SLA.0000000000000788
10.1097/SLA.0000000000000788
Web of Science® Google Scholar
8FlemingFJ, KimMJ, SalloumRM, YoungKC, MonsonJR How much do we need to worry about venous thromboembolism after hospital discharge? A study of colorectal surgery patients using the National Surgical Quality Improvement Program database. Dis Colon Rectum (2010) 53: 1355–136010.1007/DCR.0b013e3181eb9b0e 20847615
10.1007/DCR.0b013e3181eb9b0e
PubMed Web of Science® Google Scholar
9PiazzaG, AndersonFA, OrtelTL, CoxMJ, RosenbergDJ, RahimianS et al. Randomized trial of physician alerts for thromboprophylaxis after discharge. Am J Med (2013) 126: 435–44210.1016/j.amjmed.2012.09.020 23510945
10.1016/j.amjmed.2012.09.020
PubMed Web of Science® Google Scholar
10DavenportDL, VargasHD, KastenMW, XenosES Timing and perioperative risk factors for in-hospital and post-discharge venous thromboembolism after colorectal cancer resection. Clin Appl Thromb Hemost (2012) 18: 569–57510.1177/1076029611433642 22345485
10.1177/1076029611433642
PubMed Web of Science® Google Scholar
11ShapiroR, VogelJD, KiranRP Risk of postoperative venous thromboembolism after laparoscopic and open colorectal surgery: an additional benefit of the minimally invasive approach?. Dis Colon Rectum (2011) 54: 1496–150210.1097/DCR.0b013e31823302a1 22067177
10.1097/DCR.0b013e31823302a1
PubMed Web of Science® Google Scholar
12 Practice parameters for the prevention of venous thromboembolism (2000) The Standards Task Force of the American Society of Colon and Rectal Surgeons. Dis Colon Rectum 43: 1037–1047
PubMed Google Scholar
13HuoMH, MuntzJ Extended thromboprophylaxis with low-molecular-weight heparins after hospital discharge in high-risk surgical and medical patients: a review. Clin Ther (2009) 31: 1129–114110.1016/j.clinthera.2009.06.002 19695383
10.1016/j.clinthera.2009.06.002
PubMed Web of Science® Google Scholar
14WisemanDN, HarrisonJ A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital. N Z Med J (2010) 123: 37–4920186241
PubMed Google Scholar
15LymanGH, KhoranaAA, FalangaA, Clarke-PearsonD, FlowersC, JahanzebM et al. American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol (2007) 25: 5490–550510.1200/JCO.2007.14.1283 17968019
10.1200/JCO.2007.14.1283
CAS PubMed Web of Science® Google Scholar
16BilimoriaKY, ChungJ, JuMH, HautER, BentremDJ, KoCY et al. Evaluation of surveillance bias and the validity of the venous thromboembolism quality measure. JAMA (2013) 310: 1482–148910.1001/jama.2013.280048 24100354
10.1001/jama.2013.280048
CAS PubMed Web of Science® Google Scholar
17 National Surgical Quality Improvement Program [home page on the Internet] (2005) American College of Surgeons, Chicago. www.acsnsqip.org
Google Scholar
18QadanM, TysonM, McCaffertyMH, HohmannSF, PolkHC Venous thromboembolism in elective operations: balancing the choices. Surgery (2008) 144: 654–66010.1016/j.surg.2008.06.019 18847651discussion 660-1
10.1016/j.surg.2008.06.019
PubMed Web of Science® Google Scholar
19MasoomiH, MoghadamyeghanehZ, MillsS, CarmichaelJC, PigazziA, StamosMJ Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome?. World J Surg (2015) 25631940
Google Scholar
20MoghadamyeghanehZ, MasoomiH, MillsSD, CarmichaelJC, PigazziA, NguyenNT et al. Outcomes of conversion of laparoscopic colorectal surgery to open surgery. JSLS (2014) 25587213
Google Scholar
21KaiserAM, KatkhoudaN Laparoscopic management of the perforated viscus. Semin Laparosc Surg (2002) 9: 46–5310.1053/slas.2002.32422 11979410
10.1053/slas.2002.32422
PubMed Google Scholar
22AgrestaF, CiardoLF, MazzaroloG, MicheletI, OrsiG, TrentinG et al. Peritonitis: laparoscopic approach. World J Emerg Surg (2006) 1: 910.1186/1749-7922-1-9 16759400
10.1186/1749-7922-1-9
PubMed Google Scholar
23AgrestaF, De SimoneP, BedinN The laparoscopic approach in abdominal emergencies: a single-center 10-year experience. JSLS (2004) 8: 25–3014974658
PubMed Google Scholar
24LorenceDP, IbrahimIA Benchmarking variation in coding accuracy across the United States. J Health Care Finance (2003) 29: 29–4212908652
PubMed Google Scholar

Citing Literature

Volume40, Issue5

May 2016

Pages 1255-1263

Post-Hospital Discharge Venous Thromboembolism in Colorectal Surgery

Abstract

Background

Methods

Results

Conclusions

References

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Post-Hospital Discharge Venous Thromboembolism in Colorectal Surgery

Abstract

Background

Methods

Results

Conclusions

References

Citing Literature

References

Related

Information