J. W. McCullough1, J. Schumacher1, D. Yang1, S. Fernandes-Taylor1, E. Lawson1 1University Of Wisconsin,Madison, WI, USA
Introduction:
The efficacy and safety of post-discharge venous thromboembolism (VTE) prophylaxis for patients undergoing major abdominal surgery for cancer has been demonstrated in numerous studies and has been recommended by multiple national organizations over the past decade. Our objective was to identify factors associated with post-discharge VTE prophylaxis after major abdominal surgery for cancer and quantify associated costs to patients and insurers.
Methods:
Adult patients undergoing a major abdominal surgical procedure (colectomy, proctectomy, pancreatectomy, hepatectomy, gastrectomy, or esophagectomy) for cancer in 2012-2015 were identified in the Marketscan® databases, which include comprehensive claims for a nationwide cohort of patients. Patients on anticoagulation preoperatively or with a VTE diagnosis prior to discharge were excluded. Use of post-discharge VTE prophylaxis and associated costs for the 28 days following surgery were assessed. Multivariable logistic regression, including demographics, comorbidities and surgical factors, assessed predictors of receipt of post-discharge VTE prophylaxis.
Results:
Of 23,509 patients undergoing major abdominal surgery for cancer, 5.6% received post-discharge VTE prophylaxis. The median cost to payers was $378 (Interquartile range $212-$579), while patient out-of-pocket costs were $10 (Interquartile range $5-$32). Receipt of post-discharge VTE prophylaxis by procedure and associated costs are displayed in the table. Compared to colectomy, patients undergoing proctectomy and pancreatectomy had significantly higher risk-adjusted odds of receiving post-discharge VTE prophylaxis (OR 1.7, p=0.01 and OR 2.1, p<0.01, respectively). Patients undergoing open procedures (OR 1.4, p<0.01) had higher odds of receiving prophylaxis, as did patients with obesity (OR 1.3, p<0.01), congestive heart failure (OR1.5, p<0.01) or metastatic disease (OR 1.5 p<0.01). In contrast, patients with anemia were significantly less likely to receive prophylaxis (OR 0.85, p=0.02). There were no significant differences in rates of post-discharge VTE prophylaxis observed between insurance plan types. However, significant variation was observed by region, with patients in the south and west regions less likely to receive post-discharge VTE prophylaxis.
Conclusion:
The vast majority of patients undergoing major abdominal surgery for cancer do not receive post-discharge VTE prophylaxis. This is despite a decade of strong recommendations for post-discharge VTE prophylaxis from national organizations. These findings suggest that substantial efforts are needed in order to change clinical practice and increase prescribing of post-discharge VTE prophylaxis for patients undergoing major abdominal surgery for cancer.
