Incidence, predictors, and outcomes of venous thromboembolism in patients hospitalized with thyroid cancer: A nationwide analysis (2016–2021).

Abstract

e18152 Background: Patients with thyroid cancer (TC), although at lower overall risk of venous thromboembolism (VTE) compared to other malignancies, are at greater risk of VTE compared with the general population. This study aims to evaluate the burden of VTE, its predictors, and impact on clinical outcomes in TC hospitalizations. Methods: We analyzed adult hospitalizations for TC with and without VTE from the 2016-2021 nationwide inpatient sample database using ICD-10 codes. We excluded pregnant women, patients with anticoagulation therapy, end-stage renal disease, and other malignancies. Demographics were compared using Pearson’s χ² tests and Student’s t-test. Primary outcomes include incidence and predictors of VTE. Secondary endpoints include impact of VTE on mortality, length of hospital stay (LOS), and hospitalization costs. Predictors of VTE, as well as the impact of VTE on mortality and other outcomes were assessed on a propensity-score-matched cohort. Illness severity, mortality risk, and comorbidity burden were adjusted using All Patient Refined Diagnosis Related Groups (APR-DRG), specifically the Loss of Function (LOF) and Likelihood of Dying (LOD). Frailty was defined based on the Johns Hopkins frailty clusters. Prolonged hospitalization was defined as length of stay (LOS) ≥12 days. Results: About 9,015 hospitalizations were included in the analysis. Incidence of VTE was 4.2% (375 hospitalizations). Hospitalizations complicated by VTE were significantly older (median age: 66 (57 – 75 years) vs. 53 (39.5 – 67 years); P<0.001) and included more non-elective hospitalizations (180 [48%] vs 1,860 [21.6%]; P<0.001). Factors associated with increased risk of VTE included female sex (aOR: 1.87; 95% CI: 1.47-2.14; P=0.037), diabetes mellitus with complication (aOR: 10.36; 95% CI: 1.41-6.14; P=0.022), major or extreme LOF at admission (aOR: 1.87; 95% CI: 1.47-2.14; P=0.037), frailty (aOR: 2.41; 95% CI: 1.63-3.23; P=0.019), major LOD at admission (aOR: 4.81; 95% CI: 2.45-5.88; P=0.010), previous MI (aOR: 1.88; 95% CI: 1.33-2.93; P=0.009), malnutrition (aOR: 3.12; 95% CI: 2.67-5.23; P=0.019) and elevated transaminases (aOR: 1.29; 95% CI: 1.08-1.58; P=0.021). Compared with other hospitalizations for TC, hospitalizations with VTE were associated with prolonged hospitalization (95 [25.3%] vs 363 [4.2%]; P<0.001) and higher hospitalization costs (median $15,398 [$8,107 – $35,138] vs. $12,080 [$7,566 – $19,085]; P=0.006). No difference in mortality was noted in patients with and without VTE during hospitalization (30 [8.0%] vs. 95 [1.1%]; aOR: 2.43; 95% CI: 0.80-7.29; P=0.113). Conclusions: Female sex, complicated diabetes, LOF, frailty, and hepatic dysfunction were important predictors of VTE. Prolonged hospitalization and higher median hospitalization costs were noted in VTE patients. No difference in mortality was seen in this population.