IMPORTANCE Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality after cancer surgery. Venous thromboembolism events that are significant enough to require hospital readmission are potentially life threatening, yet data regarding the frequency of these events beyond the 30-day postoperative period remain limited. OBJECTIVE To determine the rates, outcomes, and predictive factors of readmissions owing to VTE up to 180 days after complex cancer operations, using a national data set. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of the 2016 Nationwide Readmissions Database was performed to study adult patients readmitted with a primary VTE diagnosis. Data obtained from 197 510 visits for 126 104 patients were analyzed. This was a multicenter, population-based, nationally representative study of patients who underwent a complex cancer operation (defined as cystectomy, colectomy, esophagectomy, gastrectomy, liver/biliary resection, lung/bronchus resection, pancreatectomy, proctectomy, prostatectomy, or hysterectomy) from January 1 through September 30, 2016, for a corresponding cancer diagnosis. EXPOSURES Readmission with a primary diagnosis of VTE. MAIN OUTCOMES AND MEASURES Proportion of 30-, 90-, and 180-day VTE readmissions after complex cancer surgery, factors associated with readmissions, and outcomes observed during readmission visit, including mortality, length of stay, hospital cost, and readmission to index vs nonindex hospital. RESULTS For the 126 104 patients included in the study, 30-, 90-, and 180-day VTE-associated readmission rates were 0.6% (767 patients), 1.1% (1331 patients), and 1.7% (1449 of 83 337 patients), respectively. A majority of patients were men (58.7%), and the mean age was 65 years (SD, 11.5 years). For the 1331 patients readmitted for VTE within 90 days, 456 initial readmissions (34.3%) were to a different hospital than the index surgery hospital, median length of stay was 5 days (IQR, 3-7 days), median cost was $8102 (IQR, $5311-$10 982), and 122 patients died (9.2%). Independent factors associated with readmission included type of operation, scores for severity and risk of mortality, age of 75 to 84 years (odds ratio [OR], 1.30; 95% CI, 1.02-1.78), female sex (OR, 1.23; 95% CI, 1.11-1.37), nonelective index admission (OR, 1.31; 95% CI, 1.03-1.68), higher number of comorbidities (OR, 1.30; 95% CI, 1.06-1.60), and experiencing a major postoperative complication during the index admission (OR, 2.08; 95% CI, 1.85-2.33). CONCLUSIONS AND RELEVANCE In this cohort study, VTE-related readmissions after complex cancer surgery continued to increase well beyond 30 days after surgery. Quality improvement efforts to decrease the burden of VTE in postoperative patients should measure and account for these late VTE-related readmissions.

中文翻译：

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复杂癌症手术后静脉血栓栓塞再入院。

重要性 静脉血栓栓塞 (VTE) 是癌症手术后可预防的发病率和死亡率的主要原因。严重到需要再次入院的静脉血栓栓塞事件可能危及生命，但关于这些事件在术后 30 天后发生频率的数据仍然有限。目的 使用国家数据集确定复杂癌症手术后 180 天内因 VTE 再入院的比率、结果和预测因素。设计、地点和参与者 对 2016 年全国再入院数据库进行了一项回顾性队列研究，以研究初步诊断为 VTE 的成年再入院患者。分析了从 126 104 名患者的 197 510 次就诊中获得的数据。这是一个多中心、以人口为基础的、2016 年 1 月 1 日至 9 月 30 日接受复杂癌症手术（定义为膀胱切除术、结肠切除术、食管切除术、胃切除术、肝/胆切除术、肺/支气管切除术、胰腺切除术、直肠切除术、前列腺切除术或子宫切除术）的患者的全国代表性研究，进行相应的癌症诊断。暴露 初步诊断为 VTE 的再入院。主要结果和测量 复杂癌症手术后 30 天、90 天和 180 天 VTE 再入院的比例、与再入院相关的因素以及在再入院就诊期间观察到的结果，包括死亡率、住院时间、住院费用和再入院指数对比非指数医院。结果 对于纳入该研究的 126104 名患者，30 天、90 天和 180 天的 VTE 相关再入院率分别为 0.6%（767 名患者）、1.1%（1331 名患者）和 1. 分别为 7%（83 337 名患者中的 1449 名）。大多数患者为男性 (58.7%)，平均年龄为 65 岁（SD，11.5 岁）。对于 90 天内因 VTE 再入院的 1331 名患者，456 名 (34.3%) 初次再入院的医院与指数手术医院不同，中位住院时间为 5 天（IQR，3-7 天），中位费用为 8102 美元（ IQR，$5311-$10982)，122 名患者死亡 (9.2%)。与再入院相关的独立因素包括手术类型、严重程度评分和死亡风险、年龄 75 至 84 岁（比值比 [OR]，1.30；95% CI，1.02-1.78）、女性（OR，1.23；95 % CI, 1.11-1.37)、非选择性入院指数 (OR, 1.31; 95% CI, 1.03-1.68)、合并症数量较多 (OR, 1.30; 95% CI, 1.06-1.60)，以及在手术期间出现主要术后并发症入场指数 (OR, 2.08; 95% CI, 1. 85-2.33）。结论和相关性 在这项队列研究中，复杂癌症手术后与 VTE 相关的再入院率在手术后 30 天后继续增加。减少术后患者 VTE 负担的质量改进工作应该衡量和解释这些晚期 VTE 相关再入院。