Time Trends in the Incidence Rates of Venous Thromboembolism Following Colorectal Resection by Indication and Operative Technique

Lewis-Lloyd, Christopher A.; Crooks, Colin J.; West, Joe; Peacock, Oliver; Humes, David J.

Abstract

Aim
It is important for patient safety to assess if international changes in perioperative care, such as focus on venous thromboembolism (VTE) prevention and minimally invasive surgery have reduced the high post colectomy VTE risks previously reported. This study assesses the impact of changes in perioperative care on VTE risk following colorectal resection.

Method
Population-based cohort study of colectomy patients in England between 2000-2019 using a national database of linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Within 30-days following colectomy, absolute VTE rates per 1,000 person-years and adjusted incidence rate ratios (aIRR) using Poisson regression for the per year change in VTE risk were calculated.

Results
Of 183,791 patients, 1,337 (0.73%) developed 30-day postoperative VTE. Overall, VTE rates reduced over the 20-year study period following elective (relative risk reduction 31.25%, 95%CI 5.69%-49.88%) but not emergency surgery. Similarly, yearly changes in VTE risk reduced following minimally invasive resections (elective benign: aIRR 0.93, 95%CI 0.90-0.97, elective malignant: aIRR 0.94, 95%CI 0.91-0.98 and emergency benign: aIRR 0.96, 95%CI 0.92-1.00), but not following open resections. There was a per year VTE risk increase following open emergency malignant resections (aIRR 1.02, 95%CI 1.00-1.04).

Conclusion
Yearly VTE risks reduced following minimally invasive surgeries in the elective setting yet in contrast were static following open elective colectomies, and following emergency malignant resections increased by almost 2% per year. To reduce VTE risk, further efforts are required to implement advances in surgical care within those having emergency and or open surgery.

Citation

Lewis-Lloyd, C. A., Crooks, C. J., West, J., Peacock, O., & Humes, D. J. (2022). Time Trends in the Incidence Rates of Venous Thromboembolism Following Colorectal Resection by Indication and Operative Technique. Colorectal Disease, 24(11), 1405-1415. https://doi.org/10.1111/codi.16233

• Journal Article Type: Article
• Acceptance Date: Jun 11, 2022
• Online Publication Date: Jun 22, 2022
• Publication Date: 2022-11
• Deposit Date: Jun 17, 2022
• Publicly Available Date: Jun 23, 2023
• Journal: Colorectal Disease
• Print ISSN: 1462-8910
• Electronic ISSN: 1463-1318
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 11
• Pages: 1405-1415
• DOI: https://doi.org/10.1111/codi.16233
• Keywords: Gastroenterology
• Public URL: https://nottingham-repository.worktribe.com/output/8500615
• Publisher URL: https://onlinelibrary.wiley.com/doi/abs/10.1111/codi.16233