Incidence of Venous Thromboembolism in Patients Undergoing Surgical Treatment for Malignancy: An Analysis of ACS NSQIP Data 2005-2008

Abstract

Introduction: Venous thromboembolism (VTE) events have been associated with surgical procedures and cancer status. Pulmonary embolism is a potentially fatal event, and long term consequences of deep venous thrombosis can result in significant disability. Data regarding VTE by tumor type for surgical patients are sparse. the current study was designed to define the incidence, relative risk, and adjusted odds ratio of VTE following surgical intervention by cancer site. Methods: We performed a retrospective cohort study of patients entered into the ACS-NSQIP database from 2005-2008 who underwent a surgical procedure and had a post-operative neoplasm diagnosis. the incidence of VTE was calculated by tumor type for malignant and benign/CIS neoplasms. the relative risk of post-operative VTE for cancer was calculated by tumor site. An odds ratio was calculated for each neoplasm site using logistic regression, and controlled for body mass index (BMI), age, operative time, and sex. BMI, age and operative time were divided into categorical variables in concordance with those indicated by VTE prophylaxis guidelines. Results: All patients with a neoplasm were identified (n=130,284); 4289 cases were excluded due the uncertain behavior of the neoplasm. We identified 92,072 malignant neoplasms and 33,923 benign/CIS neoplasms, which were used as controls. the presence of colon cancer, rectal cancer, pancreatic cancer, uterine cancer, ovarian cancer, and breast cancer had statistically significant higher relative risk for VTE in patients with malignant neoplasms before controlling for patient characteristics. After controlling for age, sex, BMI and operative time, only malignancies of the large intestine, uterus, ovaries, and adrenals remained as having statically significant elevated odds ratio of developing VTE after a surgical procedure. Conclusions: The incidence of VTE is higher in patients with malignant neoplasm undergoing surgical procedures when compared to their benign counterparts. the relative risk of VTE varies by tumor type and is not uniform across patients undergoing surgical procedures. After controlling for patient characteristics known to be associated with VTE, the odds ratio of VTE remained elevated for malignancies of specific sites. Recommendations for VTE prophylaxis for patients undergoing surgical procedures should be based on the overall risk profile of the patient including an adjustment tailored to the specific type of malignancy. Table Site of Neoplasm Cancer patients with VTE (all cancer patients) Patients with benign/cis neoplasm with VTE (all benign/cis patients) Incidence per 1000 cases (cancer) Incidence per 1000 cases (benign/cis) RR P OR∗ P Gastrointestinal Esophageal 37 (730) 0 (33) 50.7 0.0 -- 0.19 -- -- Stomach 91 (2421) 5 (233) 37.6 21.5 1.78 0.14 1.52 0.38 Small Intestine 25 (994) 6 (279) 25.2 21.5 1.17 0.46 1.23+ 0.66 Large Intestine 321 (14346) 63 (4943) 22.4 12.7 1.77 <0.001 1.63 <0.001 Rectum 148 (8854) 7 (1150) 16.7 6.1 2.78 0.006 1.70 0.18 Hepatobiliary Liver 53 (1607) 11 (516) 33.0 21.3 1.57 0.18 0.86 0.68 Gallbladder 27 (1191) 10 (478) 22.7 20.5 1.11 0.78 1.09+ 0.82 Pancreas 169 (5053) 20 (933) 33.4 21.4 1.58 0.05 1.40 0.17 Endocrine/Breast Breast 71 (31451) 12 (11780) 2.3 1.0 2.22 0.009 1.22 0.53 Thyroid 5 (6416) 2 (2547) 0.8 0.8 0.99 0.64 0.99‡ 0.99 Adrenal 5 (135) 4 (788) 37.0 5.1 7.54 0.005 5.83 0.01 Parathyroid 0 (36) 3 (2657) 37.0 1.1 0 0 -- -- GU/GYN Uterus 11 (585) 8 (2490) 18.8 3.2 5.95 <0.001 8.94+ <0.001 Ovarian 13 (368) 1 (434) 35.3 2.3 15.86 <0.001 13.26 0.02 Prostate 15 (1302) 0 (3) 11.5 0.0 -- 0.97 -- -- Bladder 10 (954) 1 (52) 10.5 19.2 0.54 0.44 0.37 0.38 Open table in a new tab