Room for Improvement: The Impact of Guideline-Recommended Extended Thromboprophylaxis in Patients Undergoing Abdominal Surgery for Colorectal and Anal Cancer at a Tertiary Referral Center.

BACKGROUND

Venous thromboembolism occurs in approximately 2% of patients undergoing abdominal and pelvic surgery for cancers of the colon, rectum, and anus, and is considered preventable. The American Society of Colon and Rectal Surgeons recommends extended prophylaxis in high-risk patients, but there is low adherence to the guidelines.

OBJECTIVE

This study aims to analyze the impact of venous thromboembolism risk-guided prophylaxis in patients undergoing elective abdominal and pelvic surgeries for colorectal and anal cancers from 2016 to 2021.

DESIGN

This was a retrospective analysis.

SETTING

The study was conducted at a multisite tertiary referral academic healthcare system.

PATIENTS

Patients who underwent elective abdominal or pelvic surgery for colon, rectal or anal cancer.

MAIN OUTCOME MEASURES

Receipt of Caprini-guided venous thromboembolism prophylaxis, 90 days postoperative rate of deep vein thrombosis, pulmonary embolism, venous thromboembolism, and bleeding events.

RESULTS

A total of 3,504 patients underwent elective operations, of which 2,224 (63%) received appropriate thromboprophylaxis in the inpatient setting. In the post-discharged cohort of 2,769 patients, only 2% received appropriate thromboprophylaxis in which no thromboembolic events were observed. In the group receiving inappropriate thromboprophylaxis, at 90 days post-discharge, the deep vein thrombosis, pulmonary embolism, and venous thromboembolism rates were 0.60%, 0.40%, and 0.88%, respectively. Postoperative bleeding was not different between the two groups.

LIMITATIONS

Limitations to our study include its retrospective nature, use of aggregated electronic medical records, and single healthcare system experience.

CONCLUSION

Most patients in our healthcare system undergoing abdominal or pelvic surgery for cancers of the colon, rectum, and anus were discharged without appropriate Caprini-guided VTE prophylaxis. Risk-guided prophylaxis was associated with decreased rates of in-hospital and discharged venous thromboembolism without an increase in bleeding complications. See Video Abstract.

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