Objective: 

To assess the impact of current guidelines by reporting weekly postoperative postdischarge venous thromboembolism (VTE) rates.

Summary Background Data: 

Disparity exists between the postoperative thromboprophylaxis duration colectomy patients receive based on surgical indication, where malignant resections routinely receive 28 days extended thromboprophylaxis into the postdischarge period and benign resections do not.

Methods: 

English national cohort study of colectomy patients between 2010 and 2019 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Stratified by admission type and surgical indication, absolute incidence rates (IRs) per 1000 person-years and adjusted incidence rate ratios (aIRRs) for postdischarge VTE were calculated for the first 4 weeks following resection and postdischarge VTE IRs for each postoperative week to 12 weeks postoperative.

Results: 

Of 104,744 patients, 663 (0.63%) developed postdischarge VTE within 12 weeks after colectomy. Postdischarge VTE IRs per 1000 person-years for the first 4 weeks postoperative were low following elective resections [benign: 20.66, 95% confidence interval (CI): 13.73–31.08; malignant: 28.95, 95% CI: 23.09–36.31] and higher following emergency resections (benign: 47.31, 95% CI: 34.43–65.02; malignant: 107.18, 95% CI: 78.62–146.12). Compared with elective malignant resections, there was no difference in postdischarge VTE risk within 4 weeks following elective benign colectomy (aIRR=0.92, 95% CI: 0.56–1.50). However, postdischarge VTE risks within 4 weeks following emergency resections were significantly greater for benign (aIRR=1.89, 95% CI: 1.22–2.94) and malignant (aIRR=3.13, 95% CI: 2.06–4.76) indications compared with elective malignant colectomy.

Conclusions: 

Postdischarge VTE risk within 4 weeks of colectomy is ∼2-fold greater following emergency benign compared with elective malignant resections, suggesting emergency benign colectomy patients may benefit from extended VTE prophylaxis.

中文翻译：

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结肠切除术后出院后静脉血栓栓塞的持续时间和程度

客观的： 

通过每周报告术后出院后静脉血栓栓塞 (VTE) 率来评估当前指南的影响。

摘要背景数据： 

根据手术指征，结肠切除术患者接受的术后血栓预防持续时间存在差异，其中恶性切除术通常在出院后接受 28 天的延长血栓预防，而良性切除术则不需要。

方法： 

使用关联的初级（临床实践研究数据链）和二级（医院发作统计）护理数据对 2010 年至 2019 年结肠切除术患者进行英国国家队列研究。按入院类型和手术指征进行分层，计算切除后前 4 周的每 1000 人年绝对发病率 (IR) 和调整后的出院后 VTE 发病率比 (aIRR)，以及术后每周至 12 周的出院后 VTE IR术后。

结果： 

在 104,744 名患者中，663 名（0.63%）在结肠切除术后 12 周内出现出院后 VTE。选择性切除术后前 4 周，出院后每 1000 人年的 VTE IR 较低[良性：20.66，95% 置信区间 (CI)：13.73–31.08；恶性：28.95，95% CI：23.09-36.31] 紧急切除后更高（良性：47.31，95% CI：34.43-65.02；恶性：107.18，95% CI：78.62-146.12）。与择期恶性切除相比，择期良性结肠切除术后 4 周内出院后 VTE 风险没有差异（aIRR=0.92，95% CI：0.56-1.50）。然而，与择期恶性结肠切除术相比，紧急切除术后 4 周内，良性（aIRR=1.89，95% CI：1.22-2.94）和恶性（aIRR=3.13，95% CI：2.06-4.76）适应症的出院后 VTE 风险显着更大。

结论： 

与选择性恶性切除相比，紧急良性结肠切除术后 4 周内出院后 VTE 的风险增加约 2 倍，这表明紧急良性结肠切除患者可能受益于延长 VTE 预防。