Evidence map›Paper›PMID 37768664›Full record

ArticleJAMA network open2023

Venous Thromboembolism Chemoprophylaxis Adherence Rates After Major Cancer Surgery.

Charles D Logan, Matthew T Hudnall, Cary Jo R Schlick, Dustin D French, Brian Bartle, Dominic Vitello, Hiten D Patel, Lauren M Woldanski, Daniel E Abbott, Ryan P Merkow and 2 more

Abstract read
In one paragraph

Article in JAMA network open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Observational
  5. Article
  6. Article
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Charles D LoganNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Matthew T HudnallDepartment of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Cary Jo R SchlickNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Dustin D FrenchNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Brian BartleUS Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Hines VA Medical Center, Chicago, Illinois.
Dominic VitelloNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Hiten D PatelNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Lauren M WoldanskiDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
Daniel E AbbottDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
Ryan P MerkowNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
David D OdellNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
David J BentremNorthwestern Quality Improvement, Research, & Education in Surgery, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.

Funding

Northwestern University Minority Health and Health Disparities Research Training (NU-MHRT)T37MD014248 · NIMHD · NORTHWESTERN UNIVERSITY AT CHICAGO · PI SIMON, MELISSA A. · 2019 to 2023
$1.4M
Surgical Multispecialty Access to Research in Residency Training (SMART)R38CA245095 · NCI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI KHAN, SEEMA AHSAN · 2021 to 2024
$1.0M
Development of a Novel Statewide Learning Collaborative to Increase Lung Cancer Guideline Adherence and Improve Cancer Care DeliveryK07CA216330 · NCI · NORTHWESTERN UNIVERSITY AT CHICAGO · PI ODELL, DAVID D. · 2017 to 2021
$836k
NCI NIH HHS K07 CA216330NCI NIH HHS R38 CA245095NIMHD NIH HHS T37 MD014248
6 · The paper itself

Abstract

Importance: Venous thromboembolism (VTE) represents a major source of preventable morbidity and mortality and is a leading cause of death in the US after cancer surgery. Previous research demonstrated variability in VTE chemoprophylaxis prescribing, although it is unknown how these rates compare with performance in the Veterans Health Administration (VHA). Objective: To determine VTE rates after cancer surgery, as well as rates of inpatient and outpatient (posthospital discharge) chemoprophylaxis adherence within the VHA. Design, Setting, and Participants: This retrospective cohort study within 101 hospitals of the VHA health system included patients aged 41 years or older without preexisting bleeding disorders or anticoagulation usage who underwent surgical treatment for cancer with general surgery, thoracic surgery, or urology between January 1, 2015, and December 31, 2022. The VHA Corporate Data Warehouse, Pharmacy Benefits Management database, and the Veterans Affairs Surgical Quality Improvement Program database were used to identify eligible patients. Data analysis was conducted between January 2022 and July 2023. Exposures: Inpatient surgery for cancer with general surgery, thoracic surgery, or urology. Main Outcomes and Measures: Rates of postoperative VTE events within 30 days of surgery and VTE chemoprophylaxis adherence were determined. Multivariable Poisson regression was used to determine incidence-rate ratios of inpatient and postdischarge chemoprophylaxis adherence by surgical specialty. Results: Overall, 30 039 veterans (median [IQR] age, 67 [62-71] years; 29 386 men [97.8%]; 7771 African American or Black patients [25.9%]) who underwent surgery for cancer and were at highest risk for VTE were included. The overall postoperative VTE rate was 1.3% (385 patients) with 199 patients (0.7%) receiving a diagnosis during inpatient hospitalization and 186 patients (0.6%) receiving a diagnosis postdischarge. Inpatient chemoprophylaxis was ordered for 24 139 patients (80.4%). Inpatient chemoprophylaxis ordering rates were highest for patients who underwent procedures with general surgery (10 102 of 10 301 patients [98.1%]) and lowest for patients who underwent procedures with urology (11 471 of 17 089 patients [67.1%]). Overall, 3142 patients (10.5%) received postdischarge chemoprophylaxis, with notable variation by specialty. Conclusions and Relevance: These findings indicate the overall VTE rate after cancer surgery within the VHA is low, VHA inpatient chemoprophylaxis rates are high, and postdischarge VTE chemoprophylaxis prescribing is similar to that of non-VHA health systems. Specialty and procedure variation exists for chemoprophylaxis and may be justified given the low risks of overall and postdischarge VTE.

Indexed as

NeoplasmsVenous ThromboembolismAftercareAgedChemopreventionHumansMalePatient DischargeRetrospective Studies

Identifiers

PMID37768664
PMCPMC10539988

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.