In a retrospective cohort study reported in JAMA Network Open, Logan et al found that inpatient venous thromboembolism (VTE) chemoprophylaxis prescription rates were high and postsurgical VTE rates were low among U.S. veterans undergoing major cancer surgery.
Study Details
The study included 30,039 veterans aged ≥ 41 years from 101 hospitals in the Veterans Health Administration (VHA) health system who underwent treatment for cancer with general surgery, thoracic surgery, or urologic surgery between January 2015 and December 2022. Eligible patients had no preexisting bleeding disorders or anticoagulation receipt.
Patients had a median age of 67 years (interquartile range = 62–71 years); 29,386 (97.8%) were male, and 7,771 (25.9%) were Black. The primary outcome measure was rate of postoperative VTE events within 30 days after surgery.
Key Findings
Overall, VTE diagnosis occurred within 30 days in 385 patients (1.3%), with 199 (0.7%) diagnosed during hospitalization and 186 (0.6%) diagnosed postdischarge. Inpatient chemoprophylaxis was ordered for 24,139 patients (80.4%), with the highest rate for patients undergoing general surgery (10,102 of 10,301 = 98.1%), followed by thoracic surgery (2,566 of 2,649 = 96.9%) and urologic surgery (11,471 of 17,089 = 67.1%).
By procedure, the lowest rates of chemoprophylaxis prescription were for prostate (62.9%) and kidney surgery (68.3%). Rates were similar for lung (96.4%), esophagogastric (98.1%), esophageal (99.2%), colorectal (97.9%), hepatobiliary (95.3%), pancreatic (99.7%), and bladder surgeries (96.9%).
Postdischarge chemoprophylaxis was ordered for 3,142 patients (10.5%), with the highest rate for general surgery (1,703 patients = 16.5%), followed by urologic surgery (1,363 patients = 8.0%) and thoracic surgery (76 patients = 2.9%). As noted by the investigators, this low rate of postdischarge prophylaxis was similar to that observed in studies in non-VHA health systems.
Diagnosis of VTE occurred in:
- 159 patients (1.5%) undergoing general surgery, including 110 as inpatients and 49 in the postdischarge setting
- 36 patients (1.4%) who underwent thoracic surgery, including 24 as inpatients and 12 in the postdischarge setting
- 190 patients (1.1%) who underwent thoracic surgery, including 65 as inpatients and 125 in the postdischarge setting.
The lowest rates of VTE by procedure were for prostate (1.1%) and kidney surgeries (0.9%); the highest rates were for esophageal (3.0%), bladder (2.6%), and pancreatic surgeries (2.9%).
The investigators concluded, “These findings indicate the overall VTE rate after cancer surgery within the VHA is low, VHA inpatient chemoprophylaxis rates are high, and postdischarge VTE chemoprophylaxis prescribing is similar to that of non-VHA health systems. Specialty and procedure variation exists for chemoprophylaxis and may be justified given the low risks of overall and postdischarge VTE.”
David J. Bentrem, MD, MS, of the Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was supported by the Department of Veterans Affairs, National Cancer Institute, and others. For full disclosures of the study authors, visit jamanetwork.com.
