QS103 - A “CLOT” to Consider: Extended Venous Thromboembolism Prophylaxis After Colorectal Cancer Resection Is Low Regardless of Patient or Hospital Factors

Sunday, June 2, 2024

8:18 AM – 8:21 AM ET, USA

Location: Room 327

Quick Shot Presenter(s)

Colleen Donahue, MD (she/her/hers)

Assistant Professor
Medical University of South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States

All relevant financial disclosures have been managed and will be listed below.
This individual has no financial relationships with ineligible companies.

Author(s)

DB

Daniel Brinton, PhD

Associate Professor
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.
Ab

Alexander booth, MD

Resident
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.
MW

Maggie Westfal, MD, MPH

Assistant Professor
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.
VG

Virgilio George, MD

Professor
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.
PM

Pinckney Johnstone Maxwell, MD

Assistant Professor
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.
KS

Kit Simpson, DrPH

Professor
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.

Senior Author(s)

Thomas Curran, MD, MPH

Associate Professor
Medical University of South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States

Disclosure information not submitted.

Purpose/Background: Patients undergoing resection for colorectal cancer are at high risk for postoperative venous thromboembolism (VTE), a complication associated with significant morbidity and mortality. Extended pharmacologic VTE prophylaxis (ePPx) after major cancer surgery effectively lowers VTE risk and is recommended by major professional societies including the National Comprehensive Cancer Network, American Society of Clinical Oncology, American Academy of Chest Physicians and American Society of Colon and Rectal Surgeons. However, despite increasing evidence, adherence is low. The aim of this study was to assess patient and hospital factors associated with receipt of ePPx after colorectal cancer surgery.

Methods/Interventions: For this retrospective cohort study, we identified all patients undergoing colorectal cancer resection from 2016-2017 in the Surveillance, Epidemiology, and End Results (SEER) Medicare dataset. Our primary outcome was receipt of ePPx as indicated by filling an outpatient prescription for prophylactic dose low molecular weight heparin within 7 days of discharge. Patient and hospital factors independently associated with receiving ePPx were identified using multivariable logistic regression. Secondary outcomes included 30- and 90-day VTE.

Results/Outcomes: Of 20,680 patients, 4.1% received ePPx. ePPx compliance increased from 2016 to 2017 (3.3% vs. 4.9%; p< 0.01). Patients receiving ePPx were younger (74.8 vs. 76.6 years; p< 0.01) and more likely to have Charlson score of 2 or less (68.9% vs. 62.6%; p< 0.01). There was a trend towards white patients being more likely to receive ePPx compared to Black patients and Other race patients though this was not statistically significant (6.1% vs. 4.8% vs. 3.2%; p=0.08). Patients treated at National Cancer Institute (NCI) designated teaching hospitals received ePPx more frequently than those at teaching, non-NCI hospitals and non-teaching, non-NCI hospitals (9.5% vs. 4.9% vs. 1.4%; p< 0.01). Patients receiving care at larger hospitals by bed size quartile were more likely to receive ePPx compared to those at smaller hospitals (8.0% vs. 3.7% vs. 2.7% vs. 2.1%; p< 0.01). On multivariable regression, NCI teaching status, larger hospital bed size, White race (compared to Other) and more recent year of treatment were independently associated with ePPx utilization (Figure 1). VTE events at 30 and 90 days postoperative were 1.9% and 3.6% respectively.

Conclusion/Discussion: Despite society guidelines advocating for ePPx after major cancer surgery, utilization of ePPx after colorectal cancer resection remains limited. Acknowledging observed disparities by patient factors and treatment setting, adherence to ePPx guidelines is poor even in the highest utilization settings. Further work is needed to better understand departures from guideline concordant care.