Ethicon Biosurgery, Ethicon, Inc, Somerville, NJ, USA.
Ann Surg Oncol. 2011 Nov;18(12):3240-7. doi: 10.1245/s10434-011-1723-2. Epub 2011 May 17.
Previous studies have reported VTE rates during surgical stays in hospitals or by diagnoses over extended periods without being linked to specific surgical events. The purpose of this project was to assess the potential rate of venous thromboembolism in patients with cancer after a surgical procedure within the immediate posthospital admission period of 30 days, with special emphasis in increased sensitivity of detection.
Patients with cancer who had a major surgery were identified in a large commercial (non-Medicare) database containing data from more than 22 million patients in the United States. Those with a new diagnosis of VTE within 30 days postadmission for surgery were identified. Additional drug-based criteria were used to vary the VTE definition in a sensitivity analysis. VTE rates are reported for each of the surgical procedure group and overall.
The overall 30-day VTE rate was 3.5% with a diagnosis based definition, with rates ranging by procedure from 1.8 to 13.2%. Esophageal resection patients have a VTE rate of 13.2% (95% confidence interval (CI), 8.8-18.9%), whereas prostatectomy patients have a VTE rate of 1.8% (95% CI, 1.5-2.1%). Of the 3.5% of patients with a VTE diagnosis on or before postoperative day 30, 73% of those have the VTE diagnosis by day 14. Another 1.15% is added to the overall VTE rate as the definition sensitivity is increased with outpatient pharmacy claims data.
Using administrative data from large populations provides valuable insight into the potential VTE rates that occur within the 30-day post period after various cancer-related surgeries. The information can be used by surgeons as one component of the benefit-risk decision regarding postoperative VTE prophylaxis in surgical patients.
先前的研究报告了在医院住院期间或通过长期诊断报告的静脉血栓栓塞（VTE）发生率，但并未与特定的手术事件相关联。本项目的目的是评估在手术后立即住院的 30 天内，癌症患者发生静脉血栓栓塞的潜在发生率，特别强调检测的敏感性提高。
在一个包含美国 2200 多万患者数据的大型商业（非医疗保险）数据库中，确定接受过重大手术的癌症患者。在手术后 30 天内新诊断为 VTE 的患者被确定为研究对象。在敏感性分析中，使用额外的基于药物的标准来改变 VTE 的定义。报告了每个手术程序组和总体的 VTE 发生率。
总体 30 天 VTE 发生率为 3.5%，基于诊断的定义，各手术程序的发生率范围为 1.8%至 13.2%。食管切除术患者的 VTE 发生率为 13.2%（95%置信区间[CI]，8.8-18.9%），而前列腺切除术患者的 VTE 发生率为 1.8%（95%CI，1.5-2.1%）。在术后 30 天内确诊 VTE 的 3.5%的患者中，有 73%的患者在术后 14 天内确诊 VTE。将门诊药房理赔数据纳入整体 VTE 发生率，使定义的敏感性增加，从而使 VTE 发生率增加了 1.15%。
使用大型人群的行政数据可深入了解各种癌症相关手术后 30 天内潜在的 VTE 发生率。该信息可由外科医生作为手术患者术后 VTE 预防的获益风险决策的一个组成部分使用。
