In a U.S. retrospective cohort study reported in JAMA Surgery, Perry et al found that a very small percentage of patients filled prescriptions for guideline-recommended venous thromboembolism (VTE) prophylaxis after undergoing surgery for pancreatic cancer.
As stated by the investigators, “VTE is the most common cause of preventable death after major cancer surgery. Consequently, clinical consensus guidelines from the National Comprehensive Cancer Network, the American College of Chest Physicians, and ASCO recommend up to 28 days of postoperative VTE prophylaxis after abdominal or pelvic cancer surgeries for high-risk patients. Despite the substantial risk of VTE among patients undergoing surgery for pancreatic cancer and consensus guidelines regarding postdischarge VTE prophylaxis, adherence to guidelines in the U.S. remains unclear.”
Study Details
The study included data from 888 patients with stage I/II pancreatic adenocarcinoma who underwent resection obtained from the merged Surveillance, Epidemiology, and End Results (SEER) and Medicare databases from January 2009 to December 2013.
Key Findings
Among the 888 patients, 34 (3.8%) filled a prescription for VTE prophylaxis within 5 days of hospital discharge and 854 did not. Of the 34 patients, 24 (71%) were prescribed a 28-day total course of prophylaxis; 33 (97%) received a prescription for low–molecular-weight heparin.
There were no significant differences in demographic, clinicopathologic, or treatment characteristics between patients who did vs did not receive postdischarge prophylaxis.
Overall, deep-vein thrombosis/pulmonary embolism (DVT/PE) occurred in 28 patients (3.2%) within 30 days postdischarge.
Postdischarge prophylaxis vs no prophylaxis was not associated with significant differences in 30-day rates of overall complications (≤ 10 [presented as ≤ 10 in accordance with SEER-Medicare guidelines for patient confidentiality] vs 189 [22%], P = .09), DVT/PE (0 vs 28 [3.3%], P = .62), or bleeding events (0 vs 25 [2.9%], P = .62).
No significant differences between groups were observed for median hospital length of stay (8 vs 9 weeks, P = .25), 30-day readmissions (≤ 10 vs 317 [37%], P = .07), or 30-day mortality (0 vs ≤ 10, P > .99). A borderline significant difference was observed for 90-day readmissions (≤ 10 vs 400 [47%], P = .05). No difference was observed in median overall survival (20 vs 22 months, P = .77).
The investigators concluded, “The findings of this cohort study suggest that adherence to recommended guidelines for VTE prophylaxis is poor among patients who undergo pancreatic cancer surgery, because fewer than 5% of patients in this population were prescribed VTE prophylaxis after discharge. Potential explanations for these findings include physician knowledge, patient adherence, and/or concerns regarding bleeding complications… The low adherence to the guidelines presented herein suggests a need for better understanding of this practice gap and consideration of interventions that may optimize postoperative VTE prophylaxis use among high-risk patients.”
Sepideh Gholami, MD, of the Division of Surgical Oncology, the University of California, Davis, is the corresponding author for the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
