Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery.
Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery.
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DOI：
10.1001/jamanetworkopen.2023.35311
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发表时间：
2023-09-05
影响因子：
13.8
通讯作者：
Bentrem DJ
中科院分区：
文献类型：
--
作者：
Logan CD;Hudnall MT;Schlick CJR;French DD;Bartle B;Vitello D;Patel HD;Woldanski LM;Abbott DE;Merkow RP;Odell DD;Bentrem DJ
这项队列研究评估了癌症手术后静脉血栓栓塞率和退伍军人健康管理局内的化学预防依从率。退伍军人健康管理局内大型癌症手术后静脉血栓栓塞症(VTE)的诊断率和术后化学预防依从率是多少？在这项队列研究中，包括30名因癌症接受手术治疗的 039退伍军人，静脉血栓栓塞率的总体比率为1.3%，不同外科专业和手术地点的化学预防订购率有所不同。这些发现表明，退伍军人健康管理局内不同专业和手术地点的化学预防措施存在差异，考虑到总体VTE和出院后VTE的风险较低，这可能是合理的。静脉血栓栓塞症(VTE)是可预防的发病率和死亡率的主要来源，也是美国癌症手术后死亡的主要原因。以前的研究表明，VTE化学预防处方的可变性，尽管尚不清楚这些比率与退伍军人健康管理局(VHA)的表现如何比较。确定癌症手术后的静脉血栓栓塞率，以及住院病人和门诊病人(术后出院)在VHA内的化学预防依从率。这项在VHA卫生系统的101家医院进行的回顾性队列研究包括在2015年1月1日至2022年12月31日期间接受普通外科、胸外科或泌尿科癌症外科治疗的41岁或以上、既有出血障碍或使用抗凝药物的患者。VHA公司数据仓库、药房福利管理数据库和退伍军人事务部外科质量改进计划数据库用于确定符合条件的患者。数据分析在2022年1月至2023年7月期间进行。癌症住院手术包括普通外科、胸部外科或泌尿外科。测定术后30天内静脉血栓栓塞率和静脉血栓栓塞术的化学预防依从性。用多变量Poisson回归分析外科专科住院和出院后化疗依从性的发生率。总体而言，30名 039退伍军人(年龄中位数67[62-71]岁；29名 386名男性[97.8%]；7771名非裔美国人或黑人患者[25.9%])接受了癌症手术，是静脉血栓栓塞症的高危人群。术后静脉血栓栓塞率为1.3%(385例)，其中199例(0.7%)在住院期间确诊，186例(0.6%)在出院后确诊。24例 患者(80.4%)接受了住院化疗预防。接受普通外科手术的患者的住院化学预防订单率最高(10 102/10 301例[98.1%])，而接受泌尿外科手术的患者最低(17 089例患者中11 471例(67.1%))。总体而言，3142名患者(10.5%)接受了出院后化学预防，不同专业之间存在显著差异。这些发现表明，VHA内癌症手术后的总体VTE发生率较低，VHA住院患者的化学预防率较高，出院后VTE化学预防处方与非VHA卫生系统相似。化学预防存在特殊性和程序差异，考虑到整体和出院后静脉血栓栓塞术的低风险，这一点是合理的。
This cohort study assesses the rate of venous thromboembolism after cancer surgery and the rate of chemoprophylaxis adherence within the Veterans Health Administration. What are the rates of venous thromboembolism (VTE) diagnosis and postoperative chemoprophylaxis adherence following major cancer surgery within the Veterans Health Administration? In this cohort study including 30 039 veterans surgically treated for cancer, the overall rate of VTE rates was 1.3%, with variations in chemoprophylaxis ordering rates by surgical specialty and procedure site. These findings suggest that there is variation in chemoprophylaxis by specialty and procedure site within the Veterans Health Administration, which may be justified given the low risk of overall VTE and postdischarge VTE. Venous thromboembolism (VTE) represents a major source of preventable morbidity and mortality and is a leading cause of death in the US after cancer surgery. Previous research demonstrated variability in VTE chemoprophylaxis prescribing, although it is unknown how these rates compare with performance in the Veterans Health Administration (VHA). To determine VTE rates after cancer surgery, as well as rates of inpatient and outpatient (posthospital discharge) chemoprophylaxis adherence within the VHA. This retrospective cohort study within 101 hospitals of the VHA health system included patients aged 41 years or older without preexisting bleeding disorders or anticoagulation usage who underwent surgical treatment for cancer with general surgery, thoracic surgery, or urology between January 1, 2015, and December 31, 2022. The VHA Corporate Data Warehouse, Pharmacy Benefits Management database, and the Veterans Affairs Surgical Quality Improvement Program database were used to identify eligible patients. Data analysis was conducted between January 2022 and July 2023. Inpatient surgery for cancer with general surgery, thoracic surgery, or urology. Rates of postoperative VTE events within 30 days of surgery and VTE chemoprophylaxis adherence were determined. Multivariable Poisson regression was used to determine incidence-rate ratios of inpatient and postdischarge chemoprophylaxis adherence by surgical specialty. Overall, 30 039 veterans (median [IQR] age, 67 [62-71] years; 29 386 men [97.8%]; 7771 African American or Black patients [25.9%]) who underwent surgery for cancer and were at highest risk for VTE were included. The overall postoperative VTE rate was 1.3% (385 patients) with 199 patients (0.7%) receiving a diagnosis during inpatient hospitalization and 186 patients (0.6%) receiving a diagnosis postdischarge. Inpatient chemoprophylaxis was ordered for 24 139 patients (80.4%). Inpatient chemoprophylaxis ordering rates were highest for patients who underwent procedures with general surgery (10 102 of 10 301 patients [98.1%]) and lowest for patients who underwent procedures with urology (11 471 of 17 089 patients [67.1%]). Overall, 3142 patients (10.5%) received postdischarge chemoprophylaxis, with notable variation by specialty. These findings indicate the overall VTE rate after cancer surgery within the VHA is low, VHA inpatient chemoprophylaxis rates are high, and postdischarge VTE chemoprophylaxis prescribing is similar to that of non-VHA health systems. Specialty and procedure variation exists for chemoprophylaxis and may be justified given the low risks of overall and postdischarge VTE.
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影响因子：
45.3
作者：
Lyman, Gary H.;Khorana, Alok A.;Falanga, Anna
通讯作者：
Falanga, Anna
影响因子：
9
作者：
Yang, Anthony D.;Hewitt, Daniel Brock;Bilimoria, Karl Y.
通讯作者：
Bilimoria, Karl Y.
影响因子：
3.4
作者：
Shargall, Yaron;Wiercioch, Wojtek;Litle, Virginia R.
通讯作者：
Litle, Virginia R.
影响因子：
9
作者：
Khorfan R;Kreutzer L;Love R;Schlick CJR;Chia M;Bilimoria KY;Yang AD
通讯作者：
Yang AD
影响因子：
2.9
作者：
Cronin, MaryAnne;Dengler, Nancy;Caprini, Joseph A.
通讯作者：
Caprini, Joseph A.