Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study

Abstract

Background: Venous thromboembolism (VTE) is a common and serious complication after colorectal cancer (CRC) surgery. Few large-sample studies have reported VTE incidence and management status after CRC surgery in China. This study aimed to investigate the incidence and prevention of VTE in Chinese patients after CRC surgery, identify risk factors for developing VTE, and construct a new scoring system for clinical decision-making and care planning.

Methods: Participants were recruited from 46 centers in 17 provinces in China. Patients were followed up for 1 month postoperatively. The study period was from May 2021 to May 2022. The Caprini score risk stratification and VTE prevention and incidence were recorded. The predictors of the occurrence of VTE after surgery were identified by multivariate logistic regression analysis, and a prediction model (CRC-VTE score) was developed.

Results: A total of 1836 patients were analyzed. The postoperative Caprini scores ranged from 1 to 16 points, with a median of 6 points. Of these, 10.1% were classified as low risk (0-2 points), 7.4% as moderate risk (3-4 points), and 82.5% as high risk (≥5 points). Among these patients, 1210 (65.9%) received pharmacological prophylaxis, and 1061 (57.8%) received mechanical prophylaxis. The incidence of short-term VTE events after CRC surgery was 11.2% (95% CI 9.8-12.7), including deep venous thrombosis (DVT) (11.0%, 95% CI 9.6-12.5) and pulmonary embolism (PE) (0.2%, 95% CI 0-0.5). Multifactorial analysis showed that age (≥70 years), history of varicose veins in the lower extremities, cardiac insufficiency, female sex, preoperative bowel obstruction, preoperative bloody/tarry stool, and anesthesia time at least 180 min were independent risk factors for postoperative VTE. The CRC-VTE model was developed from these seven factors and had good VTE predictive performance ( C -statistic 0.72, 95% CI 0.68-0.76).

Conclusions: This study provided a national perspective on the incidence and prevention of VTE after CRC surgery in China. The study offers guidance for VTE prevention in patients after CRC surgery. A practical CRC-VTE risk predictive model was proposed.

Figure 1

Caprini score risk stratification and prevention status of colorectal cancer (CRC) patients. (A) Risk stratification based on Caprini score and prophylaxis for high-risk patients at admission. (B) Risk stratification based on Caprini score and prophylaxis for high-risk patients within 24 h after CRC surgery. (C) Postoperative pharmacological and physical prophylaxis for CRC patients. (D) Start time and duration of drug prophylaxis after CRC surgery. GCS, graduated compression stockings; IPCD, intermittent pneumatic compression devices; LMWH, low-molecular weight heparin; VTE, venous thromboembolism.

Figure 2

The model development overview. (A) Division of the training and validation sets. (B) Independent risk factors and corresponding scores associated with VTE occurrence in patients after colorectal cancer (CRC) surgery. (C) VTE incidence was distinguished by score quartiles (low risk, 0–1; moderate risk, 2–3; high risk, 4–5; very high risk, ≥6), with an exponential increase in VTE incidence among top-quartile patients. (D) Risk stratification based on the Caprini-CRC scoring system. VTE, venous thromboembolism.