Venous thromboembolism (VTE) is a serious complication associated with surgery performed in the large intestine (colorectal surgery) and its prevention has been promoted as a measure of utmost importance regarding patient safety by several healthcare agencies. Nevertheless the frequency and risk factors of this complication following colorectal surgery in the era of modern VTE prevention are still unknown.
Now, a recent study published in the JAMA Surgery journal has provided a more definitive answer. The Colorectal Writing Group for the Surgical Care and Outcomes Assessment Program–Comparative Effectiveness Research Translation Network (SCOAP-CERTAIN) Collaborative looked at data from 52 Washington State hospitals describing VTE complications during hospital stay and up to 3 months after undergoing colorectal surgery between 2006 and 2011.
VTE happens when a blood clot (thrombus) forms within a vein. Colorectal surgery is often performed for inflammatory disease or cancer, which are known risk factors for VTE. Not only that, but some procedures and the surgery itself are also known to be associated with a higher rate of VTE. A common type of venous thrombosis includes deep vein thrombosis, which is a blood clot in the deep veins of the leg. If this blood clot breaks loose and travels in the blood, it can reach the lungs and give rise to a life-threatening pulmonary embolism. As such, it is very important that doctors use several strategies to prevent it, including several classes of heparin, a blood thinner (anticoagulant medication).
Researchers studied 16,120 patients and concluded that the use of perioperative and in-hospital VTE prevention increased significantly to 86-91% by 2011. Nevertheless, 40% of all VTEs happened within the first 3 months after discharge from the hospital and only 11% of patients were using extended (at home) VTE prevention.
Consequently, although VTE remains an infrequent surgical complication it can be severe and even life-threatening. The fact that only a small fraction of patients receive VTE prevention after hospital discharge is an indication that there is a need for better guidelines and space for improvement of quality of care. These findings are important, not only for future studies to specifically address the issue of extended prevention but also to guideline issuing agencies throughout the world.