Pellino G, Sciaudone G, Candilio G, De Fatico G S, Canonico S, Selvaggi F
Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy.
Acta Chir Belg. 2015 Jul-Aug;115(4):288-92. doi: 10.1080/00015458.2015.11681114.
Patients undergoing colorectal surgery are at risk of developing venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). Knowing predictors of VTE could help preventing this life-threatening complication.
We collected data of patients undergoing colorectal surgery at our Unit between 2009 and 2014. Baseline characteristics, type of surgery, and postoperative complications were gathered. A univariate regression analysis was performed with symptomatic VTE as outcome. Pre-, intra- and postoperative clinical factors were separately tested. All variables significantly associated with VTE occurring within three months from the discharge were entered in the final multivariate regression model.
A total of 476 patients were included. Symptomatic VTE occurred in 13 patients (2.7%). Six (46.1%) occurred after hospital discharge. Preoperative variables associated with VTE were: advanced age at surgery (OR 2.3, 95%CI 1.8-5.6), smoking (OR 1.7, 95%CI 1.2-2.5), inflammatory bowel diseases (OR 2.1, 95%CI 1.5-4.3), advanced pelvic malignancies (OR 2.4, 95%CI 2.0-4.2), and obesity (OR 1.5, 95%CI 1.1-2.1). Prolonged pelvic manipulation (OR 1.8, 95%CI 1.1-4.3) and steep Trendelenburg position (OR 2.4, 95%CI 1.9-5.0) were intraoperative predictors of VTE, while stockings significantly reduced the risk (OR 0.8, 95%CI 0.4-0.9). Late mobilization (OR 2.5, 95%CI 2.0-4.6) and septic complications (OR 1.4, 95%CI 1.2-3.7) were postoperative predictors of VTE, whereas anticoagulants administered for at least 3 weeks after discharge were associated with lower VTE risk (OR 0.5, 95%CI 0.2-0.8).
We observed several modifiable predictors of VTE. Patients with ≥2 risk factors undergoing colorectal surgery could benefit from a more intensive VTE preventive pathway.
接受结直肠手术的患者有发生静脉血栓栓塞症（VTE）的风险，包括深静脉血栓形成（DVT）和肺栓塞（PE）。了解VTE的预测因素有助于预防这种危及生命的并发症。
我们收集了2009年至2014年间在本单位接受结直肠手术患者的数据。收集了基线特征、手术类型和术后并发症。以有症状的VTE为结果进行单因素回归分析。分别测试术前、术中和术后的临床因素。所有与出院后三个月内发生的VTE显著相关的变量都被纳入最终的多因素回归模型。
共纳入476例患者。13例（2.7%）发生有症状的VTE。6例（46.1%）发生在出院后。与VTE相关的术前变量有：手术时年龄较大（比值比[OR]2.3，95%置信区间[CI]1.8 - 5.6）、吸烟（OR 1.7，95%CI 1.2 - 2.5）、炎症性肠病（OR 2.1，95%CI 1.5 - 4.3）、晚期盆腔恶性肿瘤（OR 2.4，95%CI 2.0 - 4.2）和肥胖（OR 1.5，95%CI 1.1 - 2.1）。长时间盆腔操作（OR 1.8，95%CI 1.1 - 4.3）和陡峭的头低脚高位（OR 2.4，95%CI 1.9 - 5.0）是术中VTE的预测因素，而使用弹力袜可显著降低风险（OR 0.8，95%CI 0.4 - 0.9）。活动延迟（OR 2.5，95%CI 2.0 - 4.6）和感染性并发症（OR 1.4，95%CI 1.2 - 3.7）是术后VTE的预测因素，而出院后至少使用3周抗凝剂与较低的VTE风险相关（OR 0.5，95%CI 0.2 - 0.8）。
我们观察到了几种可改变的VTE预测因素。接受结直肠手术且有≥2个危险因素的患者可能会从更强化的VTE预防方案中获益。
