Increase in VTE related hospital readmissions after complex cancer surgery

April 2022 Clinical practice Nalinee Pathak

According to a new study, hospital readmission after complex cancer surgeries due to Venous thromboembolism (VTE) continues to increase after 30 days. These findings were reported in the journal JAMA Surgery.

VTE is a significant cause of morbidity and mortality during the post-operative period that is significant enough to require hospital readmission. Despite these events being life-threatening, minimal data about the frequency of these events after complex cancer surgery is available.

Study design

A multicentre, population-based, retrospective study analysed data from 197,510 visits for 126 104 patients (mean age, 65 years; standard deviation, 11.5; 58.7% men) readmitted with a primary VTE diagnosis who underwent a complex operation (cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy or hysterectomy) between Jan. 1 to Sept. 30, 2016. The researchers evaluated VTE related readmissions after 30, 90 and 180 days of surgery, factors associated with readmissions, and clinical outcomes during their stay at the hospital.

Results

The VTE-associated readmission rates were 0.6% (n=767), 1.1% (n=1,331), and 1.7% (1449 of 83,337 patients) within 30, 90 and 180 days of surgery, respectively. Among the 1,331 patients readmitted within 90 days, 34.3% (n=456) had been readmitted to another hospital than the index surgery hospital. The median hospital stay was 5 days at a median cost of $8,102, and 122 (9.2%) died during their stay at the hospital. In fact, the researchers noted that 15.8% of patients died during readmission due to VTE. The factors associated with hospital readmissions included the operation type, scores for severity and risk of mortality, age of 75 to 84 years (odds ratio [OR], 1.30; 95% CI, 1.02-1.78), female sex (OR, 1.23; 95% CI, 1.11-1.37), nonelective index admission (OR, 1.31; 95% CI, 1.03-1.68), higher number of comorbidities (OR, 1.30; 95% CI, 1.06-1.60), and experiencing a major postoperative complication during the index admission (OR, 2.08; 95% CI, 1.85-2.33).

Conclusion

The study demonstrates the presence of preventable complications after complex cancer surgery. Hence, high-risk patients might benefit from extended monitoring for VTE.

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

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