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- Title
Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population-based cohort study.
- Authors
Vendler, M. M. I.; Haidari, T. A.; Waage, J. E.; Kleif, J.; Kristensen, B.; Gögenur, I.; Bertelsen, C. A.; Neuenschwander, Anders U.; Jansen, Jens E.; Rasmussen, Leif A.; Jepsen, Lars V.; Bols, Birgitte; Ingeholm, Peter; Iversen, Else R.; Kirkegaard‐Klitbo, Anders; Tenma, Jutaka R.; Wilhelmsen, Michael
- Abstract
Aim Both the Danish and the National Institute of Clinical Excellence ( NICE) guidelines recommend prolonged thromboprophylaxis ( PT) with low-molecular-weight heparin ( LMWH) for 28 days postoperatively after elective surgery for colon cancer. The evidence relies on data from two randomized clinical trials ( RCTs) that included not only colon cancers but also other abdominal cancers or benign colorectal diseases. Neither of those studies investigated the risk of venous thromboembolism ( VTE) under enhanced recovery after surgery ( ERAS). We aim to describe the risk of VTE and estimate the cost of preventing one case of VTE by PT under ERAS. Method This was a retrospective study of 2230 patients undergoing elective surgery for colon cancer Stage I- III in the Capital Region of Denmark, 1 June 2008 to 31 December 2013. Patients who were discharged on postoperative day 28 or later, died during admission or were discharged with a vitamin K antagonist, novel oral anticoagulants or LMWH were excluded. Patients with rectal cancer only were not included. End-points were symptomatic VTE diagnosed within 60 days postoperatively. Results Three-hundred and thirty patients were excluded. For the remaining 1893, the median length of stay ( LOS) was 4 [interquartile range ( IQR): 3-5] days. Of these 1893 patients, four (0.20%) experienced a nonfatal symptomatic VTE. All four patients had other postoperative complications before the VTE. The cost of each symptomatic VTE prevented is estimated to be between £63 709 and £111 455 when medication and home-care nursing are included. Conclusion The risk of symptomatic VTE after uncomplicated, elective surgery for colon cancer with ERAS seems negligible and the cost-effectiveness of PT to prevent one symptomatic VTE seems questionable.
- Subjects
COLON cancer treatment; THROMBOEMBOLISM; THROMBOEMBOLISM treatment; POSTOPERATIVE care; GREAT Britain. National Institute of Clinical Excellence; PATIENTS
- Publication
Colorectal Disease, 2017, Vol 19, Issue 11, pO393
- ISSN
1462-8910
- Publication type
Article
- DOI
10.1111/codi.13910