Dong Kelly, Fuccello Ashlynn, Schootman Mario, Martin Bradley C, Mavros Michail N
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2025 May 24. doi: 10.1245/s10434-025-17465-9.
Current guidelines recommend extended venous thromboembolism (VTE) prophylaxis for 4 weeks following pancreas surgery for cancer; however, adherence to these guidelines is low.
This is a retrospective analysis of the 2007-2020 SEER-Medicare dataset for patients with primary pancreas cancer undergoing pancreas surgery. The primary outcome was the filling of a prescription for extended VTE prophylaxis within 5 days of discharge. The independent variables included patient demographics, social determinants of health, comorbidities, and cancer and treatment characteristics. We used multivariable logistic regression to identify variables independently associated with extended VTE prophylaxis.
We identified 4,827 eligible operations (72% pancreatoduodenectomies). The median age was 73 years, and 54.7% were female. Extended VTE prophylaxis prescriptions were filled for 469 patients (9.7%), primarily with enoxaparin (96.2% of prescriptions). Filling of extended VTE prescriptions increased over time (0.4% in 2008 to 23.1% in 2019). After risk adjustment, factors independently associated with receipt of extended VTE prophylaxis included younger age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.01-1.04), white race (OR 2.2 [1.5-3.4]), rurality (nonmetropolitan area vs. metropolitan >1 million population, OR 1.6 [1.2-2.1]), pancreatoduodenectomy (vs. other pancreas surgery, OR 1.4 [1.1-1.8]), higher pancreatectomy hospital volume (4th vs. 1st quartile, OR 2.3 [1.5-3.5]), surgical oncologist provider specialty (OR 2.3 [1.9-2.8]), and surgery period (2016-2019 vs. 2008-2011, OR 5.9 [4.2-8.6]).
Prescription of extended VTE prophylaxis after pancreas cancer surgery has been modest but increasing. Disparities in the receipt of extended VTE prophylaxis are multifactorial, mostly stemming from demographic and healthcare-related factors.
当前指南建议对胰腺癌胰腺手术后的患者进行为期4周的延长静脉血栓栓塞（VTE）预防；然而，对这些指南的依从性较低。
这是一项对2007 - 2020年SEER - 医疗保险数据集进行的回顾性分析，研究对象为接受胰腺手术的原发性胰腺癌患者。主要结局是出院后5天内开具延长VTE预防药物的处方。自变量包括患者人口统计学特征、健康的社会决定因素、合并症以及癌症和治疗特征。我们使用多变量逻辑回归来确定与延长VTE预防独立相关的变量。
我们确定了4827例符合条件的手术（72%为胰十二指肠切除术）。中位年龄为73岁，54.7%为女性。469例患者（9.7%）开具了延长VTE预防药物的处方，主要使用依诺肝素（占处方的96.2%）。延长VTE处方的开具率随时间增加（2008年为0.4%，2019年为23.1%）。经过风险调整后，与接受延长VTE预防独立相关的因素包括年龄较小（比值比[OR] 1.02，95%置信区间[CI] 1.01 - 1.04）、白人种族（OR 2.2 [1.5 - 3.4]）、农村地区（非都市地区与人口超过100万的都市地区相比，OR 1.6 [1.2 - 2.1]）、胰十二指肠切除术（与其他胰腺手术相比，OR 1.4 [1.1 - 1.8]）、胰腺切除手术量较高的医院（第4四分位数与第1四分位数相比，OR 2.3 [1.5 - 3.5]）、外科肿瘤学家提供者专业（OR 2.3 [1.9 - 2.8]）以及手术时期（2016 - 2019年与2008 - 2011年相比，OR 5.9 [4.2 - 8.6]）。
胰腺癌手术后延长VTE预防的处方率虽低但呈上升趋势。接受延长VTE预防存在差异是多因素的，主要源于人口统计学和医疗保健相关因素。
