Abstract
Background
Extended venous thromboembolism prophylaxis after abdominopelvic cancer surgery has
not been widely adopted. We compared outcomes of patients pre- and postimplementation
of extended venous thromboembolism prophylaxis with low molecular weight heparin.
Methods
Prospectively collected data from a quality initiative project aimed at prescribing
extended venous thromboembolism prophylaxis after abdominopelvic cancer surgery was
compared with previously published data from a prospective cohort without extended
venous thromboembolism prophylaxis. The primary outcome was 6-month postoperative
symptomatic venous thromboembolism incidence. Secondary outcomes: differences in 1-
and 3-month venous thromboembolism incidence and factors associated with venous thromboembolism
using Cox-proportional hazard models. Cumulative incidence of venous thromboembolism
was estimated using Kaplan-Meier methods and expressed as proportions with 95% confidence
interval.
Results
There were 241 patients in the venous thromboembolism-prophylaxis cohort and 284 patients
in the no venous thromboembolism prophylaxis cohort. Patients in the venous thromboembolism-prophylaxis
cohort were more likely to be female (69% vs 60%, P = .018), have metastatic disease (49% vs 29%, P < .001), have longer operative times (236 min vs 197 min, P < .001), and to receive neoadjuvant chemotherapy (27% vs 23%, P = .006). Respectively, the 1- (0.5% [95% confidence interval, 0.1–2.5] vs 0.4% [95%
confidence interval, 0.1–2.5]), 3- (2.6% [95% confidence interval, 1.2–5.6] vs 2.5%
[95% confidence interval, 1.2–5.2]), and 6-month (7.5% [95% confidence interval, 4.8–11.5]
vs 7.2% [95% confidence interval, 4.7–11.0]) venous thromboembolism incidence were
similar. By multivariable analysis, history of venous thromboembolism (hazard ratio
3.52; 95% confidence interval, 1.03–12.05; P = .045) and longer duration of hospital stay (hazard ratio 1.07; 95% confidence interval,
1.01–1.12; P = .016) demonstrated increased risk of venous thromboembolism.
Conclusion
This study failed to demonstrate a decreased 1-, 3-, and 6-month postoperative venous
thromboembolism incidence after the implementation of extended venous thromboembolism
prophylaxis.
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Article info
Publication history
Published online: February 10, 2022
Accepted:
December 30,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
