Moghadamyeghaneh Zhobin, Hanna Mark H, Carmichael Joseph C, Nguyen Ninh T, Stamos Michael J
Department of Surgery, University of California, Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
J Gastrointest Surg. 2014 Dec;18(12):2169-77. doi: 10.1007/s11605-014-2647-5. Epub 2014 Sep 12.
There are limited data regarding predictive factors of postoperative venous thromboembolism (VTE) in patients undergoing colorectal resection. We sought to identify associations between patient comorbidities and postoperative VTE in colorectal resection. The National Surgical Quality Improvement Program (NSQIP) database was used to examine clinical data of patients experiencing postoperative VTE after colorectal resection from 2005 to 2011. Multivariate analysis using logistic regression was performed to quantify risk factors of VTE. We sampled 116,029 patients undergoing colorectal resection. The rate of VTE was 2 % (2,278) with 0.2 % (182) having deep vein thrombosis (DVT) and pulmonary embolism (PE). The first week after operation was the most common time for postoperative VTE. A significant number of patients suffering DVT and PE were diagnosed after index hospital discharge (PE 34.6 %, DVT 29.3 %). The most important risk factors identified for DVT include (P < 0.05) ASA score >2 (adjusted odds ratio (AOR) 1.77) and hypoalbuminemia (serum albumin level <3.5 mg/dl) (AOR 1.69). The most important factors had associations with PE include (P < 0.05) DVT (AOR 14.60) and disseminated cancer (AOR 1.70). Ulcerative colitis (AOR 1.48, P = 0.01) and stage 4 cancer (AOR 1.29, P = 0.02) have associations with DVT. Open colorectal procedures have higher risk of DVT compared to laparoscopic procedures (AOR 1.33, P < 0.01). Postoperative VTE occurs in 2 % of colorectal resections. Thirty percent of VTE events were diagnosed after discharge. Prophylactic treatment of VTE after discharge may have benefits in high-risk patients. Thirteen and eleven perioperative risk factors have associations with DVT and PE, respectively. Emergent admission, open procedures, ulcerative colitis, and stage 4 cancer patients have increased risk of DVT.
关于接受结直肠切除术患者术后静脉血栓栓塞（VTE）预测因素的数据有限。我们试图确定患者合并症与结直肠切除术后VTE之间的关联。使用国家外科质量改进计划（NSQIP）数据库来检查2005年至2011年接受结直肠切除术后发生VTE患者的临床数据。采用逻辑回归进行多变量分析以量化VTE的危险因素。我们抽取了116,029例接受结直肠切除术的患者。VTE发生率为2%（2,278例），其中0.2%（182例）发生深静脉血栓形成（DVT）和肺栓塞（PE）。术后第一周是术后VTE最常见的时间。相当数量的DVT和PE患者在出院后被诊断出来（PE为34.6%，DVT为29.3%）。确定的DVT最重要的危险因素包括（P<0.05）美国麻醉医师协会（ASA）评分>2（调整优势比（AOR）为1.77）和低白蛋白血症（血清白蛋白水平<3.5mg/dl）（AOR为1.69）。与PE相关的最重要因素包括（P<0.05）DVT（AOR为14.60）和播散性癌症（AOR为1.70）。溃疡性结肠炎（AOR为1.48，P=0.01）和4期癌症（AOR为1.29，P=0.02）与DVT有关。与腹腔镜手术相比，开放性结直肠手术发生DVT的风险更高（AOR为1.33，P<0.01）。结直肠切除术中2%的患者发生术后VTE。30%的VTE事件在出院后被诊断出来。出院后对VTE进行预防性治疗可能对高危患者有益。分别有13个和11个围手术期危险因素与DVT和PE有关。急诊入院、开放性手术、溃疡性结肠炎和4期癌症患者发生DVT的风险增加。
