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Purpose: SCIP measures target prophylaxis for venous thromboembolism (VTE), during the hospital phase for patients undergoing surgery; some patients nevertheless develop VTE after discharge. We aim to characterize the risk of post-discharge VTE after colorectal surgery and risk factors that may suggest the need for the consideration of an extended postoperative VTE prophylaxis beyond the hospital phase.

Methods: The ACS-NSQIP dataset from 2005-2007 was used to identity patients undergoing colectomy or proctectomy. Patients who developed deep venous thrombosis or pulmonary embolism were identified and sorted into pre or post discharge events. Univariate and multivariate analysis was done to identify risk factors for post-discharge VTE.

Results: 30,900 patients undergoing laparoscopic and open resection of the colon and rectum for benign and malignant conditions were identified. 567 patients developed DVT with 149 (26%) diagnosed post-discharge. 232 cases of pulmonary embolism were identified with 82 (35%) diagnosed post-discharge. Factors associated with the post-discharge risk for VTE included open vs. laparoscopic surgery (0.77% vs. 0.47%, p<0.05), no resident vs. presence of resident (0.91% vs. 0.62%, p<0.05), steroid use (1.5% vs. 0.61%, p<0.05), reoperation (1.3% vs. 0.65%, p<0.05), BMI >30 (p<0.05)and higher ASA class (p<0.05).

Conclusion: A substantial fraction of overall VTE (DVT and PE) occurs post-discharge in patients undergoing colorectal resection, this risk higher in patients with higher ASA class, on perioperative steroids and undergoing open surgery and reoperation. These findings strongly support the consideration of extension of VTE prophylaxis to the post-discharge (at home) period after colorectal resection in patients with these identified risk factors.
Univariate Analysis for Post-Discharge VTE

Variable	Overall N=30900	No Post-Discharge VTE	Post-Discharge VTE	p value
Age <70yrs Age >70ys	20150 (65.2%) 10750 (34.8%)	20018 (99.3%) 10672 (99.3%)	132 (0.66%) 78 (0.73%)	0.47
Female Male	15961 (51.7%) 14936 (48.3%)	15855 (99.3%) 14832 (99.3%)	106 (0.66%) 104 (0.70%)	0.73
Colectomy Proctectomy	28328 (91.7%) 2572 (8.3%)	28131 (99.3%) 2559 (99.5%)	197 (0.70%) 13 (0.51%)	0.26
Laparoscopic Open	8966 (29.2%) 21764 (70.8%)	8924 (99.5%) 21596 (99.2%)	42 (0.47%) 168 (0.77%)	0.004*
No Resident Resident	7044 (22.9%) 23679 (77.1%)	6980 (99.1%) 23533 (99.4%)	64 (0.91%) 146 (0.62%)	0.009*
No Metastatic Cancer Metastatic Cancer	29410 (95.2%) 1490 (4.8%)	29213 (99.3%) 1477 (99.1%)	197 (0.67%) 13 (0.87%)	0.35
No Steroid Use Steroid Use	28437 (92.0%) 2463 (8.0%)	28263 (99.4%) 2427 (98.5%)	174 (0.61%) 36 (1.5%)	<0.001*
No Sepsis SIRS Sepsis Septic Shock	26460 (85.6%) 2729 (8.8%) 826 (2.7%) 885 (2.9%)	26287 (99.3%) 2702 (99.0%) 818 (99.0%) 883 (99.8%)	173 (0.65%) 27 (0.99%) 8 (0.97%) 2 (0.23%)	0.049*
No Operation within 30 days Operation within 30 days	23421 (96.6%) 819 (3.4%)	23269 (99.4%) 808 (98.7%)	152 (0.65%) 11 (1.3%)	0.019*
No emergency surgery Emergency surgery	25904 (83.8%) 4996 (16.2%)	25733 (99.3%) 4957 (99.2%)	171 (0.66%) 39 (0.78%)	0.34
ASA Class 1-No Disturb 2-Mild Disturb 3-Severe Disturb 4-Life Threat 5-Moribund	1047 (3.4%) 14338 (46.4%) 12591 (40.8%) 2692 (8.7%) 220 (0.71%)	1042 (99.5%) 14256 (99.4%) 12483 (99.1%) 2678 (99.5%) 219 (99.5%)	5 (0.48%) 82 (0.57%) 108 (0.86%) 14 (0.52%) 1 (0.45%)	0.037

* significant