Guideline Concordant Extended Pharmacologic Venous Thromboembolism Prophylaxis Utilization After Colorectal Cancer Resection Is Low Regardless of Patient Factors or Hospital Characteristics.

Abstract

Background: Venous thromboembolism after colorectal cancer resection is common and highly morbid. Extended pharmacologic venous thromboembolism prophylaxis after cancer surgery lowers venous thromboembolism risk and is recommended by major professional societies. Adherence is low in contemporary local and regional studies.

Objective: Assess patient and hospital factors associated with receipt of prophylaxis after colorectal cancer surgery in a national data set.

Design: Retrospective cohort study.

Settings: Surveillance, epidemiology, and end results Medicare dataset.

Patients: Patients over age 64 undergoing resection for colorectal cancer between 2016 and 2017.

Main outcome measures: Primary outcome was receipt of prophylaxis within 7 days of discharge. Patient and hospital factors associated with receiving prophylaxis were identified using multivariable logistic regression. Secondary outcomes included 30- and 90-day venous thromboembolism.

Results: Of 23,527 patients, 4.7% received prophylaxis. Utilization increased from 2016 to 2017 (3.9% vs. 5.5%; p < 0.001). Patients treated at National Cancer Institute designated hospitals received prophylaxis more frequently than teaching, non-National Cancer Institute hospitals and non-teaching, non-National Cancer Institute hospitals (10.2% vs. 5.6% vs. 1.7%; p < 0.001). Patients receiving care at larger hospitals by bed size quartile were more likely to receive prophylaxis compared to those at smaller hospitals (9.0% vs. 4.0% vs. 3.4% vs. 2.2%; p < 0.01). On multivariable regression, National Cancer Institute status, larger bed size, White race (compared to other), rectal tumor location and more recent year of treatment were independently associated with prophylaxis utilization. Venous thromboembolism events at 30- and 90-days were 1.87% and 2.63%, respectively. Prophylaxis was associated with decreased 30-day venous thromboembolism (1.26% vs. 1.9%; p = 0.1211).

Limitations: Retrospective, large database study.

Conclusions: Utilization of prophylaxis after colorectal cancer surgery remains limited even in large, specialized hospitals. Further work is needed to understand this departure from guideline concordant care. See Video Abstract.