Guideline-Concordant Provision of Extended Prophylaxis for Venous Thromboembolism After Major Cancer Surgery Differs by Social and Structural Determinants of Health

IntroductionPatients undergoing major cancer surgery face an increased risk of venous thromboembolism. Despite guidelines recommending extended pharmacologic prophylaxis for 30 days after surgery, adoption remains low. Differences in adherence to guidelines for extended prophylaxis based on social and structural determinants of health have not been examined, but if present, may contribute to observed disparities in cancer surgery outcomes.MethodsA single-center retrospective cohort study was performed to identify patients undergoing major gastrointestinal, gynecologic, or urologic cancer resections between 2014 and 2021. Extended prophylaxis was assessed via outpatient low molecular weight heparin prescriptions on hospital discharge and analyzed by demographic factors (age, sex, race, poverty status, and insurance), and procedural factors (organ category, surgical approach, and year) using chi-squared tests and multivariable logistic regression.ResultsOf 5246 patients, 17.1% received extended prophylaxis, varying by specialty. Extended prophylaxis was higher with increasing age, female sex, and Medicare or Medicaid insurance, but lower among below poverty level (14.3% vs 18.1%), Black (14.5% vs 18.2%), and minimally invasive surgery patients (7.9% vs 23.9%). Multivariable regression showed lower odds of receiving extended prophylaxis for below poverty level (adjusted odds ratio 0.73, 95% CI: 0.60-0.88) and Black patients (0.72, 95% CI: 0.58-0.89).DiscussionOverall utilization of extended prophylaxis is low (17.1%) while differences in use based on income and race suggest potentially modifiable factors related to social and structural determinants of health. A planned randomized trial (NCT6451003) will test patient and provider education interventions and a decision-support tool to improve guideline adherence and potentially address cancer disparities.