EP349 - Colon Cancer is not Associated with an Increased Risk of Venous Thromboembolism after Colorectal Surgery: a NSQIP Analysis

Sunday, May 11, 2025

8:10 AM – 8:15 AM PT

Location: Monitor 9, Sails Pavilion, Upper Level

ePoster Presenter(s)

GC

Gloria Y. Chang, MD (she/her/hers)

Surgery Resident
University of Texas Southwestern
Dallas, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Seyed Ali Mousavi Almaleki, MD (he/him/his)

Research Associate
University of Texas Southwestern Medical Center
Dallas, TX, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
AK

Amudhan Kannan, MD

Research Associate
University of Texas at Southwestern
Dallas, Texas, United States

Disclosure information not submitted.
JS

Javier Salgado Pogacnik, MD

Faculty
UT Southwestern
Dallas, Texas, United States

Disclosure information not submitted.
SC

Sitaram Chilakamarry, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
LX

Lai Xue, MD FACS

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Emina Huang, MD

Professor
Surgery
University of Texas
Dallas, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
LL

Laindy Liu, MD FACS

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure information not submitted.
AS

Alessandra Storino Gonzalez, MD FACS

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

Disclosure information not submitted.

Senior Author(s)

FA

Fadwa Ali, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, Texas, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Gloria Y. Chang, MD: This individual has no financial relationships with ineligible companies.

Seyed Ali Mousavi Almaleki, MD: This individual has no financial relationships with ineligible companies.

Sitaram Chilakamarry, MD: This individual has no financial relationships with ineligible companies.

Lai Xue, MD FACS: This individual has no financial relationships with ineligible companies.

Emina Huang, MD: This individual has no financial relationships with ineligible companies.

Fadwa Ali, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Post-operative venous thromboembolism (VTE) is a significant, preventable complication following major abdominal surgery. The incidence of VTE following colorectal surgery ranges from 1.1% to 2.5%. Due to literature demonstrating an elevated VTE risk for patients undergoing major abdominal surgery for malignancy compared to benign disease, extended prophylaxis has been recommended for cancer-related abdominal surgeries. However, the last two decades have seen a significant rise of minimally invasive techniques including laparoscopy and the robotic approach as well as more widespread adoption of enhanced recovery after surgery (ERAS) protocols. The impact of the contemporary changes to surgical approach on VTE-incidence and therefore the need for continued extended VTE prophylaxis for patients undergoing colectomy remains unclear. We hypothesize that a diagnosis of colon cancer is not an independent risk factor for VTE after colorectal surgery in the modern era.

Methods/Interventions: The 2016-2022 American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) data registry was queried to identify adult patients (≥18 years) undergoing colectomy for diverticular disease or colon cancer. A multivariable logistic regression model was employed to evaluate the incidence of 30-day VTE and its association with patient characteristics, surgical approach, and postoperative outcomes.

Results/Outcomes: Of the 262,359 total patients, 171,809 underwent colectomy for diverticulitis and 90,550 for colon cancer. The majority of cases were performed with a minimally invasive surgical approach (49.1% laparoscopic and 13.8% robotic) versus 31.8% with an open surgical approach and 5.3% undergoing an unplanned conversion to open surgery. The overall 30-day VTE incidence was 1.6% with no significant difference between the diverticulitis and cancer groups (1.6% vs 1.7%, p=0.082). On multivariable analysis, key factors associated with a higher 30-day VTE incidence included post-operative length of stay greater than 7 days (OR 4.23, CI 3.43-5.22, p< 0.001), emergency surgery (OR 1.52, CI 1.15-2.00, p=0.003), open surgical approach (OR 1.5, CI 1.20-1.88, p< 0.001), unplanned conversion to open (OR 1.82, CI 1.28-2.59, p< 0.001), and significant preoperative weight loss (≥10% body weight loss in the last 6 months) (OR 1.62, CI 1.15-2.28, p=0.006) (Figure 1). A diagnosis of colon cancer was not significantly associated with 30-day incidence of VTE (OR 1.06, CI 0.84-1.34, p=0.59).

Conclusion/Discussion: In this NSQIP analysis, the overall 30-day VTE incidence following colectomy was 1.6% with no significant difference between colectomy performed for cancer and diverticular disease. Factors such as prolonged postoperative stay, emergency procedures, and open approach were associated with elevated VTE incidence. The use of extended prophylaxis for patients undergoing colectomy for colon cancer may benefit from re-examination. Further investigation into a multitude of risk factors including surgical approach, length of stay, and perioperative condition is needed to more precisely identify patients who may benefit from extended prophylaxis regardless of their underlying diagnosis.