Hospital readmissions for venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, continue to increase well beyond 30 days after complex cancer surgery and are associated with high costs and death, according to new study findings.
Among 126,104 patients from the 2016 Nationwide Readmissions Database, readmission rates for VTE were 0.6%, 1.1%, and 1.7% at 30-, 90-, and 180-days after cancer surgery, respectively, Syed Nabeel Zafar, MD, MPH, of the University of Wisconsin in Madison, Wisconsin, and colleagues reported in JAMA Surgery. VTE was a primary diagnosis in 15.8% of deaths during hospital readmission following cancer surgery.
A total of 1331 patients were readmitted for VTE within 90 days. Median length of stay was 5 days and median cost was $8102.
Readmission risks differed by operation, the investigators reported. The 90-day VTE-related readmission rate was highest among patients who had cystectomy (2.3%) or pancreatectomy (1.7%). Compared with colectomy (referent), cystectomy, pancreatectomy, esophagectomy, and liver/biliary resection were significantly associated with 2.6-, 1.9, 1.5-, and 1.4-fold increased odds, respectively, of a VTE-related readmission within 90 days. Prostatectomy, lung/bronchus resection, and hysterectomy were significantly associated with 22%, 25%, and 86% decreased odds of a VTE-related readmission within the period.
The VTE-related readmission rate at 180 days ranged from 1.1% of patients who underwent prostatectomy to 3.3% of patients who underwent cystectomy. For prostatectomy, VTE-related readmission rates plateaued by 60 days.
Several other factors were significantly associated with increased probability of readmission, including age 75 to 84 years, female sex, nonelective index admission, higher number of comorbidities, scores for illness severity and risk of mortality, and experiencing a major postoperative complication during the index admission.
“These severe VTE events are a potentially preventable delayed complication after complex cancer surgery,” Dr Zafar’s team wrote. “Understanding timing and patterns of VTE-related readmission is necessary to develop strategies to reduce the burden.”
The investigators suggested that high-risk patients might benefit from extended monitoring for VTE and/or prolonged VTE prophylaxis.
Mallick S, Aiken T, Varley P, et al. Readmissions from venous thromboembolism after complex cancer surgery. JAMA Surg. Published online January 26, 2022. doi:10.1001/jamasurg.2021.7126