Long-Term Rates of Hospital Readmission for Venous Thromboembolism After Complex Cancer Surgery

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In a U.S. retrospective cohort study reported in JAMA Surgery, Mallick et al found that hospital readmission for venous thromboembolism events (VTEs) continued beyond 30 days after complex cancer surgery.

As stated by the investigators: “…VTE is a major cause of preventable morbidity and mortality after cancer surgery. VTE events that are significant enough to require hospital readmission are potentially life-threatening, yet data regarding the frequency of these events beyond the 30-day postoperative period remain limited.”

Study Details

The study involved data from the 2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database. The analysis included 197,510 visits for 126,104 patients who underwent complex surgery between January and September 2016 with no discharge diagnosis of VTE. Complex surgery was defined as cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy, and hysterectomy. Most patients were men (58.7%), and the mean age was 65 ± 11.5 years.

The proportions of patients with readmission for a primary VTE diagnosis at 30, 90, and 180 days after surgery were ascertained, and risk factors for readmission were identified.

Key Findings

Among the 126,104 patients, VTE-associated readmission occurred for 767 patients (0.6%) by 30 days and 1,331 patients (1.1%) by 90 days. The analysis of 180-day readmissions included 83,337 patients undergoing surgery between January and June; among them, 1,449 (1.7%) were readmitted for VTE by day 180.

Among the 1,331 patients readmitted within 90 days, 456 readmissions (34.3%) were to a hospital that was not the index surgery hospital, median length of stay was 5 days (interquartile range [IQR] = 3–7 days), median cost was $8,102 (IQR = $5,311–$10,982), and 122 (9.2%) died (9.2%).

On multivariate analysis, factors significantly associated with increased 90-day readmission for VTE included the following: type of operation (odds ratios [ORs] vs colon resection of 2.57 for cystectomy, 1.45 for esophagectomy, 1.38 for liver/biliary resection, and 1.88 for pancreatectomy); severity of illness scores (ORs = 1.60 for moderate, 1.60 for major, and 3.54 for extreme); mortality risk scores (ORs = 2.12 for moderate, 3.48 for major, and 3.10 for extreme); age 75–84 vs 18–44 years (OR = 1.30); female sex (OR = 1.23); nonelective index admission (OR = 1.31); higher number of comorbidities (OR = 1.30); and experience of a major postoperative complication during index admission (OR = 2.08).

Compared with colon resection, lung/bronchus resection (OR = 0.75), prostatectomy (OR = 0.78), and hysterectomy (OR = 0.14) were associated with significantly reduced risk of readmission for VTE, with no difference in risk observed for proctectomy or gastrectomy. Laparoscopic surgery was associated with a  significantly reduced risk (OR = 0.66). Receipt of adjuvant chemotherapy was not significantly associated with risk.

The investigators concluded: “In this cohort study, VTE-related readmissions after complex cancer surgery continued to increase well beyond 30 days after surgery. Quality improvement efforts to decrease the burden of VTE in postoperative patients should measure and account for these late VTE-related readmissions.”

Syed Nabeel Zafar, MD, MPH, of the Division of Surgical Oncology, University of Wisconsin School of Medicine and Public Health, Madison, is the corresponding author of the JAMA Surgery article.

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