Journal of surgical oncology · 2026
Venous Thromboembolism Risk and Prevention After Gastrointestinal Cancer Surgery: Real World Evidence From a Large Integrated Healthcare System.
СтатьяНазвание и аннотация: Перевод в очереди
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Qi Tong, Liu In-Lu Amy, Wu Yi-Lin, Park Stacy J, Dehal Ahmed N, Gould Michael K
Аннотация
BACKGROUND AND METHODS: Venous thromboembolism (VTE) is common and preventable following surgery for gastrointestinal (GI) cancer. In this retrospective cohort study, we aimed to characterize VTE risk factors, prophylaxis, and outcomes among patients who underwent surgery for GI cancer between 2019 and 2021 at Kaiser Permanente Southern California. The discrimination of the Caprini and IMPROVE risk models for predicting VTE was assessed using the area under the receiver operating characteristic curve (AUC).
RESULTS: Among 2702 patients, the 90-day incidence of perioperative VTE was 2.1%. VTE was associated with older age, prior VTE, thrombophilia, low serum albumin, and blood transfusion, but not procedure time or surgical approach. VTE was especially common among patients with gastric cancer (4.5%). In-hospital prophylaxis was nearly universal, but post-discharge prophylaxis was uncommonly utilized (22.9%). VTE was associated with a five-fold increase in 90-day mortality. Both Caprini (AUC 0.65, 95% CI 0.57-0.72) and IMPROVE (AUC 0.65, 95% CI 0.57-0.73) models demonstrated only fair discrimination.
CONCLUSIONS: Despite adherence with recommended in-hospital prophylaxis, VTE remains an important complication following GI cancer surgery, carrying with it an increased risk of mortality.
DISCUSSION: Suboptimal discrimination of risk prediction models and underutilization of post-discharge prophylaxis represent ongoing opportunities for quality improvement.
RESULTS: Among 2702 patients, the 90-day incidence of perioperative VTE was 2.1%. VTE was associated with older age, prior VTE, thrombophilia, low serum albumin, and blood transfusion, but not procedure time or surgical approach. VTE was especially common among patients with gastric cancer (4.5%). In-hospital prophylaxis was nearly universal, but post-discharge prophylaxis was uncommonly utilized (22.9%). VTE was associated with a five-fold increase in 90-day mortality. Both Caprini (AUC 0.65, 95% CI 0.57-0.72) and IMPROVE (AUC 0.65, 95% CI 0.57-0.73) models demonstrated only fair discrimination.
CONCLUSIONS: Despite adherence with recommended in-hospital prophylaxis, VTE remains an important complication following GI cancer surgery, carrying with it an increased risk of mortality.
DISCUSSION: Suboptimal discrimination of risk prediction models and underutilization of post-discharge prophylaxis represent ongoing opportunities for quality improvement.