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Venous Thromboembolism Risk and Prevention After Gastrointestinal Cancer Surgery: Real World Evidence From a Large
Tong Qi1, In-Lu Amy Liu2, Yi-Lin Wu2
1Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
Journal of Surgical Oncology
|May 24, 2026
Summary
Venous thromboembolism (VTE) is a significant risk after gastrointestinal cancer surgery. Despite in-hospital prophylaxis, VTE increases mortality, highlighting needs for better risk prediction and post-discharge care.
Area of Science:
- Oncology
- Vascular Surgery
- Epidemiology
Background:
- Venous thromboembolism (VTE) is a common, preventable complication after gastrointestinal (GI) cancer surgery.
- Understanding VTE risk factors, prophylaxis, and outcomes is crucial for patient care.
Purpose of the Study:
- To characterize VTE risk factors, prophylaxis use, and outcomes in GI cancer surgery patients.
- To assess the predictive performance of Caprini and IMPROVE risk models for VTE.
Main Methods:
- Retrospective cohort study of 2702 GI cancer surgery patients (2019-2021).
- VTE incidence, associated factors, and prophylaxis (in-hospital and post-discharge) were analyzed.
- Area Under the Curve (AUC) evaluated Caprini and IMPROVE model discrimination.
Main Results:
- The 90-day VTE incidence was 2.1%, notably higher in gastric cancer patients (4.5%).
- VTE linked to older age, prior VTE, thrombophilia, low albumin, and blood transfusion.
- In-hospital prophylaxis was common; post-discharge prophylaxis was underutilized (22.9%).
- VTE increased 90-day mortality five-fold. Both risk models showed only fair discrimination (AUC ~0.65).
Conclusions:
- VTE is a critical complication post-GI cancer surgery, associated with increased mortality.
- Underutilization of post-discharge prophylaxis and fair risk model discrimination present quality improvement opportunities.
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