Readmissions From Venous Thromboembolism After Complex Cancer Surgery

Abstract

IMPORTANCE Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality after cancer surgery. Venous thromboembolism events that are significant enough to require hospital readmission are potentially life threatening, yet data regarding the frequency of these events beyond the 30-day postoperative period remain limited.OBJECTIVE To determine the rates, outcomes, and predictive factors of readmissions owing to VTE up to 180 days after complex cancer operations, using a national data set. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study of the 2016 Nationwide Readmissions Database was performed to study adult patients readmitted with a primary VTE diagnosis. Data obtained from 197 510 visits for 126 104 patients were analyzed. This was a multicenter, population-based, nationally representative study of patients who underwent a complex cancer operation (defined as cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy, or hysterectomy) from January 1 through September 30, 2016, for a corresponding cancer diagnosis. EXPOSURES Readmission with a primary diagnosis of VTE.MAIN OUTCOMES AND MEASURES Proportion of 30-, 90-, and 180-day VTE readmissions after complex cancer surgery, factors associated with readmissions, and outcomes observed during readmission visit, including mortality, length of stay, hospital cost, and readmission to index vs nonindex hospital. RESULTSFor the 126 104 patients included in the study, 30-, 90-, and 180-day VTE-associated readmission rates were 0.6% (767 patients), 1.1% (1331 patients), and 1.7% (1449 of 83 337 patients), respectively. A majority of patients were men (58.7%), and the mean age was 65 years (SD, 11.5 years). For the 1331 patients readmitted for VTE within 90 days, 456 initial readmissions (34.3%) were to a different hospital than the index surgery hospital, median length of stay was 5 days (IQR, 3-7 days), median cost was $8102 (IQR, $5311-$10 982), and 122 patients died (9.2%). Independent factors associated with readmission included type of operation, 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,, 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). CONCLUSIONS AND RELEVANCEIn this cohort study, VTE-related readmissions after complex cancer surgery continued to increase well beyond 30 days after surgery. Quality improvement efforts to decrease the burden of VTE in postoperative patients should measure and account for these late VTE-related readmissions.

Venous thromboembolism in cancer surgery: A report from the nationwide readmissions database

“…With increasing attention to value-based care, several investigators have examined resource use ascribed to VTE following oncologic procedures [ 6 , 30 ]. In a recent report, Mallick and colleagues found increased rates of readmission following diagnosis of VTE after hospital discharge across a wide array of cancer operations [ 6 ].…”

“…With increasing attention to value-based care, several investigators have examined resource use ascribed to VTE following oncologic procedures [ 6 , 30 ]. In a recent report, Mallick and colleagues found increased rates of readmission following diagnosis of VTE after hospital discharge across a wide array of cancer operations [ 6 ]. In the present work, we directly examined the impact of VTE during index hospitalization and found significant associations between its development and hospitalization costs, nonhome discharge, and all-cause readmission.…”

“…We identified all adult elective hospitalizations for major thoracic and abdominal cancer operations: esophageal, pulmonary, gastric, pancreatic, hepatobiliary, colonic, and rectal resections with a corresponding cancer diagnosis. Previously published International Classification of Disease, Tenth Revision ( ICD-10 ) Procedure Codes were used to identify selected operations, and ICD-10 Diagnosis Codes were used to corroborate corresponding cancer diagnoses [ 6 ]. We included discharges up to October of each calendar year to allow for adequate 90-day follow-up for all patients in the study.…”

“…The diagnoses of acute pulmonary embolism and deep venous thromboembolism, collectively venous thromboembolism (VTE), were ascertained using previously published ICD-10 codes [ 6 ]. Patient and hospital characteristics were defined according to the NRD Data Dictionary and included age, sex, and primary payer along with hospital location and teaching status [ 18 ].…”

“…Although much of the literature on VTE during hospitalization for cancer surgery is dated, recent work by Mallick et al and Jarvis et al has demonstrated that the risk of VTE extends beyond the immediate postoperative period [ 6 , 7 ]. Accordingly, recommendations from several organizations including the American Society of Clinical Oncology and the American Society of Hematology have specifically targeted VTE prophylaxis among cancer patients in both the inpatient setting and postdischarge [ 8 , 9 , 10 ].…”