Major Cancer Surgery Research Articles

Testing of a risk-stratified patient decision aid to facilitate shared decision-making for extended postoperative thromboprophylaxis after major abdominal surgery for cancer.

Use of extended pharmacologic thromboprophylaxis after major abdominopelvic cancer surgery should depend on best-available scientific evidence and patients' informed preferences. We developed a risk-stratified patient decision aid to facilitate shared decision-making and sought to evaluate its effect on decision-making quality regarding use of extended thromboprophylaxis. We enrolled patients undergoing major abdominopelvic cancer surgery at an academic tertiary care centre in this pre-post study. We evaluated change in decisional conflict, readiness to decide, decision-making confidence, and change in patient knowledge. Participants were provided the appropriate risk-stratified decision aid (according to their Caprini score) in either the preoperative or postoperative setting. A sample size calculation determined that we required 17 patients to demonstrate whether the decision aid meaningfully reduced decisional conflict. We used the Wilcoxon matched-pairs signed ranks test for interval scaled measures. We included 17 participants. The decision aid significantly reduced decisional conflict (median decisional conflict score 2.37 [range 1.00-3.81] v. 1.3 [range 1.00-3.25], p < 0.01). With the decision aid, participants had high confidence (median 86.4 [range 15.91-100]) and felt highly prepared to make a decision (median 90 [range 55-100]). Median knowledge scores increased from 50% (range 0%-100%) to 75% (range 25%-100%). Our risk-stratified, evidence-based decision aid on extended thromboprophylaxis after major abdominopelvic surgery significantly improved decision-making quality. Further research is needed to evaluate the usability and feasibility of this decision aid in the perioperative setting.

Hierarchical clustering analysis for predicting 30-day readmissions after major surgery for prostate cancer.

311 Background: Effective risk assessment techniques and follow-up strategies are scarce for patients with prostate cancer because of the heterogeneity of the population. We aimed to conduct a study for better risk stratification, applying machine learning–based classification to patients with prostate cancer who underwent major surgery. Methods: We identified eligible patients who underwent prostatectomy or surgeries related to excision of the prostate using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) for the years 2016–2021. Hierarchical clustering was conducted with variables such as age, BMI, smoking status, taking HTN medication, past medical history (diabetes, COPD, and CHF), preoperative labs (Na, BUN, creatinine, WBC count, HCT, and platelet count), operation time in minutes, and major complications. A multivariate logistic regression analysis was also conducted with a 30-day readmission as an outcome. The model accounted for cluster groups (high risk vs. low risk), among other variables. Results: The median [Q1, Q3] age of the sample ( n = 83,776) was 65.0 [59.0, 69.0] years. The participants were divided into two clusters (low-risk cluster, n = 72891; high-risk cluster, n = 10885) by hierarchical clustering, using 31 clinical variables. Patients in the high-risk cluster showed higher median levels of BUN (21 vs. 16 mg/dL), WBC count (7 vs. 6.5 /uL), platelet count (225 vs. 221/μL), and operation time (231 vs. 197 minutes). 30-day readmission rates were higher among the high-risk cluster (12.1% vs. 5.4%; p &lt; 0.001). Similar trends were observed for minor complications (10.7% vs. 5.2%), major complications (8% vs. 2.5%), and reoperation (3.4% vs. 1.3%). Results from logistic regression showed that cases in the high-risk cluster were 1.10 (95% CI: 1.03, 1.17; p &lt; 0.0015) times as likely to return to the hospital within 30 days of discharge as compared to the cases in the low-risk cluster (AUROC: 78.6%). Conclusions: In our study, hierarchical clustering divided prostate cancer cases into subgroups with a higher 30-day readmission risk. Applying machine learning–derived classification to prostate cancer patients undergoing major surgery may contribute to better risk stratification, leading to better prognosis and follow-up strategies.[Table: see text]

Identifying racial disparities in adverse dispositions following major surgery for prostate cancer using machine learning.

269 Background: Machine learning has shown potential in accurately predicting outcomes after urologic surgery, allowing for improved patient selection, risk stratification, and predicting discharge dispositions. Healthcare disparities pose a major public health challenge, leading to unequal health outcomes for different patient groups. Successful measures to mitigate these disparities rely on precise recognition of the demographic groups impacted. In this study, we utilized AI and ML models to predict such adverse outcomes so that early intervention may lead to timely and optimal prostate cancer care. Methods: Using the 2016–2021 ACS National Surgical Quality Improvement Program (NSQIP) data, we identified 84,064 patients who underwent prostatectomy or surgeries related to excision of the prostate. We used Gradient Boosted Trees, Random Forests, and Deep Learning to examine the association between various variables from demographic, clinical, preoperative labs, past medical history domains, and non-home discharge disposition after cancer surgery. Accuracy rates were utilized to compare various models. Results: The median [Q1, Q3] age of the sample was 65.0 [59.0, 69.0] years. The total median [Q1, Q3] hospital length of stay and operation time of the sample was 1.0 [1.0, 2.0] days and 200.0 [153.0, 257.0] minutes, respectively. White non-Hispanic (WNH) patients constituted 62% (n = 52,444) of the sample, and Black non-Hispanic (BNH) were 11% (n = 9547). Smoking prevalence was higher among BNH cases (18.6%) as compared to WNH cases (10.9%). The proportion of cases requiring hypertension medication was 66.6% among BNH compared to 52.6% among WNH. The 30-day readmission rates for WNH, BNH, and White Hispanic (WH) cases were 6.4%, 6%, and 5.6%, respectively. The mortality rates for WNH, BNH, and WH cases were 0.3%, 0.3%, and 0.2%, respectively. The non-home discharge rates for WNH, BNH, and WH cases were 19.8%, 20.6%, and 22.4%, respectively. The machine learning model results showed that the Deep Learning model performed best in predicting discharge disposition after prostatectomy for prostate cancer, with an accuracy of 80.48%. Race was present in the list of important factors, indicating that race had a significant association with the outcome. Conclusions: Our study demonstrated that using a national registry, ML models can accurately identify patient populations affected by healthcare disparities. We found that racial disparities in adverse dispositions persisted after adjusting for covariates. Interventions aimed at reducing these disparities are warranted to improve the quality of life of this subgroup of patients. [Table: see text]

Predictors and Significance of Readmission after Esophagogastric Surgery: A Nationwide Analysis.

The aim of this study is to identify risk factors for readmission after elective esophagogastric cancer surgery and characterize the impact of readmission on long-term survival. The study will also identify whether the location of readmission to either the hospital that performed the primary surgery (index hospital) or another institution (nonindex hospital) has an impact on postoperative mortality. Over the past decade, the center-volume relationship has driven the centralization of major cancer surgery, which has led to improvements in perioperative mortality. However, the impact of readmission, especially to nonindex centers, on long-term mortality remains unclear. This was a national population-based cohort study using Hospital Episode Statistics of adult patients undergoing esophagectomy and gastrectomy in England between January 2008 and December 2019. This study included 27,592 patients, of which overall readmission rates were 25.1% (index 15.3% and nonindex 9.8%). The primary cause of readmission to an index hospital was surgical in 45.2% and 23.7% in nonindex readmissions. Patients with no readmissions had significantly longer survival than those with readmissions (median: 4.5 vs 3.8 years; P < 0.001). Patients readmitted to their index hospital had significantly improved survival as compared to nonindex readmissions (median: 3.3 vs 4.7 years; P < 0.001). Minimally invasive surgery and surgery performed in high-volume centers had improved 90-day mortality (odds ratio, 0.75; P < 0.001; odds ratio, 0.60; P < 0.001). Patients requiring readmission to the hospital after surgery have an increased risk of mortality, which is worsened by readmission to a nonindex institution. Patients requiring readmission to the hospital should be assessed and admitted, if required, to their index institution.

Association between preoperative frailty and surgical Apgar score in abdominal cancer surgery: a secondary analysis of a prospective observational study

IntroductionThe surgical Apgar score is useful for predicting postoperative morbidity and mortality. However, its applicability in frail patients with minimal hemodynamic variation remains unknown. This study aimed to investigate the association between frailty and surgical Apgar score.MethodsThis secondary analysis included 210 patients ≥ 65 years of age undergoing elective major abdominal surgery for cancer. Frailty was assessed using the Fried Frailty Phenotype Questionnaire and defined as a total score of ≥ 3. The surgical Apgar score (range, 0−10; including mean blood pressure, heart rate, and blood loss volume) was compared between patients with or without frailty using the Mann–Whitney U test. Postoperative severe complications and length of postoperative stay were compared between patients with surgical Apgar scores ≤ 7 and > 7.ResultsAmong the included patients, 45 were classified as frail. The median [1st quartile, 3rd quartile] surgical Apgar scores in patients with and without frailty were 7.0 [7.0, 8.0] and 8.0 [7.0, 8.0], respectively (P = 0.03). Patients with surgical Apgar score ≤7 had a higher incidence of serious postoperative complications (P = 0.03) and longer hospital stays (P < 0.001) compared with patients with surgical Apgar score >7.ConclusionFrail patients have lower SAS, and patients with lower SAS have higher postoperative complication rates and longer hospital stays in patients who underwent cancer surgery.

Actual physical activity after major abdominal cancer surgery: Far from optimal

BackgroundEnhanced recovery after surgery protocols emphasize the importance of early postoperative mobilization. However, literature quantifying actual physical activity after major abdominal cancer surgery is scarce and inconclusive. Material and methodsA single-center prospective cohort study was conducted at the University Medical Center Groningen from 2019 to 2021. Patients’ postoperative physical activity was measured using an accelerometer, with the primary aim of assessing daily physical activity. Secondary aims were identifying patient-related factors associated with low physical activity and studying the consequences of low physical activity in terms of complication rate and length of hospital stay. Results143 patients included (48 % male; mean age 65 years), 38.5 %, 24.5 %, 19.6 %, and 14 % underwent pancreatic, hepatic, colorectal, or cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, respectively. Median daily step count was low; from median 71 steps on the first to 918 steps on the seventh postoperative day. An association between physical activity and age (OR 3.597, p = 0.013), preoperative weight loss ≥10 % (OR 4.984, p = 0.004), Eastern Cooperative Oncology Group performance status ≥2 (OR 4.016, p = 0.001), midline laparotomy (OR 2.851, p = 0.025), and operation duration (OR 1.003, p = 0.044) was found. An association was observed between physical activity and the occurrence of complications (OR 3.197, p = 0.039) and prolonged hospital stay (β 4.068, p = 0.013). ConclusionPostoperative physical activity is low in patients undergoing major abdominal cancer surgery and is linked to postoperative outcomes. Although physical activity should be encouraged in all patients, patient-specific risk factors were identified that can aid early recognition of patients at risk of low physical activity.

The association of perioperative blood transfusion with survival outcomes after major cancer surgery: a population-based cohort study in South Korea.

The correlation between perioperative blood transfusions and the prognosis after major cancer surgery remains controversial. We investigated the association between perioperative blood transfusion and survival outcomes following major cancer surgeries and analyzed trends in perioperative blood transfusions. Data for this population-based cohort study were obtained from the National Health Insurance Service of South Korea. Adult patients who underwent major cancer surgery between January 1, 2016, and December 31, 2020, were included. The primary endpoint was 90-day mortality. The final analysis included 253,016 patients, of which 55,094 (21.8%) received perioperative blood transfusions. In the multivariable logistic regression model, select factors, including neoadjuvant/adjuvant chemotherapy, an increased preoperative Charlson Comorbidity Index, moderate or severe liver disease, liver cancer surgery, and small bowel cancer surgery, were associated with an increased likelihood of blood transfusion. In the multivariable Cox regression model, patients who received blood transfusion had a significantly higher risk of 90-day mortality (hazard ratio: 5.68; 95% confidence interval: 5.37, 6.00; P < 0.001) than those who did not. We identified potential risk factors for perioperative blood transfusions. Blood transfusion is associated with an increased 90-day mortality risk after major cancer surgery.

The impact of family-synchronized empowerment education on the feelings of shame and quality of life of patients discharged with catheters following major surgery for cervical cancer

The impact of family-synchronized empowerment education on the feelings of shame and quality of life of patients discharged with catheters following major surgery for cervical cancer

Severe Hypomagnesemia-induced Cerebellar Ataxia after Major Gastrointestinal Cancer Surgeries: A Report of Two Cases

Severe Hypomagnesemia-induced Cerebellar Ataxia after Major Gastrointestinal Cancer Surgeries: A Report of Two Cases

One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy.

Multimodal prehabilitation is the process of enhancing physiological, nutritional, and psychological resilience to increase patients' functional capacity before major cancer surgery and aims to empower the patient to withstand the pending stress of major surgery and ultimately to improve long-term outcomes. The effect of physical prehabilitation to counteract the physical decline in surgical cancer patients has been documented; however, long-term results have not yet been published. This follow-up study aims to evaluate 1-year results on the efficacy of physical prehabilitation after bladder cancer surgery. The efficacy of prehabilitation was measured over the course of 1 year in 107 patients randomized to (1) pre- and rehabilitation or (2) standard care divided by n = 50 in the intervention (I) and n = 57 in the standard group (S). Physical function was measured by muscle leg power, and nutritional status was expressed with handgrip strength. Prehabilitation in major bladder cancer surgery can significantly improve physical function with 19.8 Watt/kg (p = 0.04), lean body mass (p = 0.047) and body cell mass (p = 0.03), and regained nutritional status one year after surgery. The results demonstrate that the restoration of physical function is vital to a full recovery.

Malnutrition screening with NRS-2002 prior to assessment as part of glim criteria in patients undergoing major abdominal surgery for gastrointestinal cancer

Malnutrition screening with NRS-2002 prior to assessment as part of glim criteria in patients undergoing major abdominal surgery for gastrointestinal cancer

Mortality Risk After a Major Cancer Surgery Is Associated With Preoperative Exposure to Air Pollution: A Nationwide Cohort Study in South Korea.

The aim of the study is to examine whether preoprerative exposure to air pollution is associated with mortality after a major cancer surgery. All patients who underwent major cancer surgeries after hospitalization between January 1, 2016, to December 31, 2020, were included. In total, 244,766 patients who underwent major cancer surgeries were included. Both 0.001-ppm increase in sulfur dioxide and 0.1-ppm increase in carbon monoxide were associated with a 7% increase in 90-day mortality rate after a major cancer surgery. Furthermore, a 0.001-ppm increase in sulfur dioxide, 0.1 ppm increase in carbon monoxide, and 1 μg/m 3 increase in particulate matter 2.5 were associated with a 4%, 3%, and 1% increase in 1-year all-cause mortality rate after a major cancer surgery. Preoperative exposure to air pollution was associated with an increased risk of mortality in patients after major cancer surgery.

Race, Ethnicity, and Sustained Opioid Use After Major Abdominal Surgery for Cancer.

Sustained opioid use is a well-known complication after surgery. Our objective was to determine whether there is any association between a patient's race or ethnicity and the sustained use of opioids in the year following surgery. Opioid use over the initial 3, 6, and 12 postoperative months was categorized as "sustained early", persistent, and chronic, respectively. Single-institution retrospective study of adults (≥18 years) who had undergone open abdominal surgery for cancer. Multivariable logistic regression was used to evaluate the association between race/ethnicity and opioid use. Of the 3523 patients included in the study, 2543 (72.2%) were non-Hispanic (NH) White, 476 (13.5%) were Hispanic or Latino, 262 (7.4%) were NH-Black, 186 (5.3%) were Asian, and 56 (1.6%) belonged to other racial or ethnic groups. The overall rates of sustained early, persistent, and chronic opioid use were 15.9%, 7.1%, and 2.6%, respectively. In the multivariable analysis, patient race/ethnicity was associated with sustained early postoperative opioid use (p-value=0.037), with Hispanics/Latinos having significantly higher odds than NH-Whites (OR = 1.382 [95% CI: 1.057-1.808]; p = 0.018). However, neither persistent nor chronic opioid use was associated with race/ethnicity (p = 0.697 and p = 0.443, respectively). In this retrospective study of adults who had undergone open abdominal surgery, patient race/ethnicity was not consistently associated with the development of sustained opioid use over the first 12 postoperative months.

Postoperative circadian patterns in wearable sensor measured heart rate: a prospective observational study

PurposeThis study aimed to describe the 24-hour cycle of wearable sensor-obtained heart rate in patients with deterioration-free recovery and to compare it with patients experiencing postoperative deterioration.MethodsA prospective observational trial was performed in patients following bariatric or major abdominal cancer surgery. A wireless accelerometer patch (Healthdot) continuously measured postoperative heart rate, both in the hospital and after discharge, for a period of 14 days. The circadian pattern, or diurnal rhythm, in the wearable sensor-obtained heart rate was described using peak, nadir and peak-nadir excursions.ResultsThe study population consisted of 137 bariatric and 100 major abdominal cancer surgery patients. In the latter group, 39 experienced postoperative deterioration. Both surgery types showed disrupted diurnal rhythm on the first postoperative days. Thereafter, the bariatric group had significantly lower peak heart rates (days 4, 7–12, 14), lower nadir heart rates (days 3–14) and larger peak-nadir excursions (days 2, 4–14). In cancer surgery patients, significantly higher nadir (days 2–5) and peak heart rates (days 2–3) were observed prior to deterioration.ConclusionsThe postoperative diurnal rhythm of heart rate is disturbed by different types of surgery. Both groups showed recovery of diurnal rhythm but in patients following cancer surgery, both peak and nadir heart rates were higher than in the bariatric surgery group. Especially nadir heart rate was identified as a potential prognostic marker for deterioration after cancer surgery.

Persistent underuse of extended venous thromboembolism prophylaxis in patients undergoing major abdominal cancer operations.

Guidelines recommend extended venous thromboembolism (VTE) prophylaxis for high-risk populations undergoing major abdominal cancer operations. Few studies have evaluated extended VTE prophylaxis in the Medicare population who are at higher risk due to age. We performed a retrospective study using a 20% random sample of Medicare claims, 2012-2017. Patients ≥65 years with an abdominal cancer undergoing resection were included. Primary outcome was the proportion of patients receiving new extended VTE prophylaxis prescriptions at discharge. Secondary outcomes included postdischarge VTE and hemorrhagic events. The study included 72 983 patients with a mean age of 75. Overall, 8.9% of patients received extended VTE prophylaxis. This proportion increased (7.2% in 2012, 10.6% in 2017; p < 0.001). Incidence of postdischarge hemorrhagic events was 1.0% in patients receiving extended VTE prophylaxis and 0.8% in those who did not. The incidence of postdischarge VTE events was 5.2% in patients receiving extended VTE prophylaxis and 2.4% in those who did not. Adherence to guideline-recommended extended VTE prophylaxis in high-risk patients undergoing major abdominal cancer operations is low. The higher rate of VTE in the prophylaxis group may suggest we captured some therapeutic anticoagulation, which would mean the actual rate of thromboprophylaxis is lower than reported herein.

Predicting the need for prophylactic gastrostomy in major head and neck cancer surgery: The PEG score.

To elaborate a preoperative score to predict the necessity of enteral nutrition at 28 days postoperatively in patients undergoing head and neck surgery. A total of 424 patients with oral cavity, oropharyngeal, laryngeal, and hypopharyngeal carcinoma were retrospectively enrolled and analyzed to identify preoperative predictors of prolonged postsurgical enteral feeding which were used to create a prediction model with an easy-to-use nomogram. Five preoperative variables (body mass index, previous radiotherapy, preoperative dysphagia, type of surgery, flap reconstruction) were found to be independent predictive factors and were used to create a prediction model named PEG score together with the related nomogram. Accuracy, F1, and the area under the curve (AUC) were 0.74, 0.83, and 0.74. Different decision thresholds can be used to vary the sensitivity and specificity. The PEG score showed high prediction performances for modeling the need for enteral nutrition at 28 days postoperatively. Prospective studies are needed to define a personalized nutrition protocol.

Clinical and economic burden of surgical complications during hospitalization for digestive cancer surgery in France.

Surgical complications and particularly infections after digestive cancer surgery remain a major health and economic problem and its burden in France is not well documented. The aim of this study was to analyse recent data regarding surgical complications in patients undergoing major digestive cancer surgery, and to estimate its burden for the French society. Using the 2018 French hospital discharge database and 2017 National CostStudy we studied hospital stays for surgical resection in patients withdigestive cancer. The population was divided into three groups based onpostoperative outcomes: no complications (NC), related infectious complications (RIC) and other complications. The main analysis compared the length and cost per stay between RIC and NC. Forty-Four thousand one hundred and twenty-three stays following a digestive cancer resection were identified. Lower gastro-intestinal cancers were the most prevalent representing 74.8% of stays, the rate of malnutrition was 32.8% and 15.8% of patients presented RIC. Mean (SD) length of stay varied from 11,7 (9.0) days for NC to 25,5 days (19.5) for RIC (p < 0.01). The mean cost per patients' stay (SD) varied from €10 641 (€ 5897) for the NC to €18 720 (€7905) for RIC (p < .01). The risk of RIC after digestive cancer resection remains high (>15%) and was associated with significantly longer length of stay and higher cost per stay. Although important prevention plans have been implemented in recent years, care strategies are still needed to alleviate the burden on patients and the healthcare system.

Effect of regional anesthesia and analgesia on long-term survival following abdominal cancer Surgery-A systematic review with meta-analysis

BackgroundThe impact of regional anesthesia and analgesia (RAA) on long-term survival following cancer surgery is a topic of debate. The aim of this study was to investigate the effects of perioperative RAA on long-term oncological outcomes in patients undergoing major abdominal cancer surgery. MethodsThe authors searched computerized databases and reference lists from inception to December 20, 2022. All studies that investigated the effects of perioperative RAA on long-term oncological outcomes following major abdominal cancer surgery were included. Using the inverse variance method with a random-effects model, hazard ratios (HR) and 95% confidence intervals (CI) were calculated. ResultsThe systematic review included 51 retrospective studies, one prospective study, and three randomized controlled trials (RCTs), with a total of 95,046 patients. The results showed that perioperative RAA may improve long-term overall survival (HR: 0.85, 95% CI: 0.80 to 0.91, P = 0.00, I2 = 60.2%). However, there was no significant association between perioperative RAA and reduced cancer recurrence (HR: 0.98, 95% CI: 0.90 to 1.03, P = 0.31, I2 = 52.3%). When performing a pooled analysis of the data from the three RCTs, no statistically significant effect of RAA was found in either case. ConclusionThe systematic review suggests perioperative RAA may improve long-term overall survival but does not appear to reduce cancer recurrence in patients undergoing major abdominal cancer surgery. The limited number of RCTs included in this study did not confirm this finding, highlighting the need for further RCTs to corroborate these results.

2116P Preoperative body mass index, waist circumference, and mortality after major cancer surgery: A nationwide cohort study in South Korea

2116P Preoperative body mass index, waist circumference, and mortality after major cancer surgery: A nationwide cohort study in South Korea

Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery

Venous thromboembolism (VTE) represents a major source of preventable morbidity and mortality and is a leading cause of death in the US after cancer surgery. Previous research demonstrated variability in VTE chemoprophylaxis prescribing, although it is unknown how these rates compare with performance in the Veterans Health Administration (VHA). To determine VTE rates after cancer surgery, as well as rates of inpatient and outpatient (posthospital discharge) chemoprophylaxis adherence within the VHA. This retrospective cohort study within 101 hospitals of the VHA health system included patients aged 41 years or older without preexisting bleeding disorders or anticoagulation usage who underwent surgical treatment for cancer with general surgery, thoracic surgery, or urology between January 1, 2015, and December 31, 2022. The VHA Corporate Data Warehouse, Pharmacy Benefits Management database, and the Veterans Affairs Surgical Quality Improvement Program database were used to identify eligible patients. Data analysis was conducted between January 2022 and July 2023. Inpatient surgery for cancer with general surgery, thoracic surgery, or urology. Rates of postoperative VTE events within 30 days of surgery and VTE chemoprophylaxis adherence were determined. Multivariable Poisson regression was used to determine incidence-rate ratios of inpatient and postdischarge chemoprophylaxis adherence by surgical specialty. Overall, 30 039 veterans (median [IQR] age, 67 [62-71] years; 29 386 men [97.8%]; 7771 African American or Black patients [25.9%]) who underwent surgery for cancer and were at highest risk for VTE were included. The overall postoperative VTE rate was 1.3% (385 patients) with 199 patients (0.7%) receiving a diagnosis during inpatient hospitalization and 186 patients (0.6%) receiving a diagnosis postdischarge. Inpatient chemoprophylaxis was ordered for 24 139 patients (80.4%). Inpatient chemoprophylaxis ordering rates were highest for patients who underwent procedures with general surgery (10 102 of 10 301 patients [98.1%]) and lowest for patients who underwent procedures with urology (11 471 of 17 089 patients [67.1%]). Overall, 3142 patients (10.5%) received postdischarge chemoprophylaxis, with notable variation by specialty. 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.