Disparities in Extended Venous Thromboembolism Prophylaxis After Pancreatic Cancer Surgery

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.