Predictors of Venous Thromboembolism After Lung Cancer Resection

BACKGROUND: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients undergoing oncologic surgery.We sought to identify risk factors for postoperative VTE to define high-risk groups which may benefit from enhanced prophylactic measures. METHODS:A retrospective cohort analysis using the STS General Thoracic Surgery Database was conducted on patients who underwent lung cancer resection between 2009-2021.Baseline characteristics and postoperative outcomes were compared between patients who did and did not develop a postoperative pulmonary embolism (PE) or deep venous thrombosis.Multivariable regression models identified risk factors associated with VTE. RESULTS:Of 57,531 patients who underwent lung cancer resection, 758 (1.3%) developed a postoperative PE.Patients with PE were more likely to be black (12% vs 7%, p<0.001), have interstitial fibrosis (3% vs 2%, p=0.016), and prior VTE (12% vs 6%, p<0.001.)Patients with locally-advanced disease who underwent bilobectomy (6% vs 4%, p<0.001) or pneumonectomy (8% vs 5%, p<0.001) were more likely to develop postoperative PE.Patients with postoperative PE had increased 30-day mortality (14% vs 3%, p<0.001), reintubation (25% vs 8%, p<0.001), and readmission (49% vs 15%, p<0.001.)On multivariable analysis, black race ], p<0.001), interstitial fibrosis (OR 1.77 [1.15-2.72],p=0.009), extent of resection, and increased operative duration were independently predictive of postoperative PE.A minimally invasive approach compared to thoracotomy was protective. CONCLUSIONS:Because non-modifiable risk factors (black race, interstitial fibrosis, and advancedstage disease) predominate in postoperative PE and VTE-associated mortality is increased, enhanced perioperative prophylactic measures should be considered in high-risk cohorts.