Momeni Arash, Fox Justin P
Ann Plast Surg. 2018 Feb;80(2):188-192. doi: 10.1097/SAP.0000000000001249.
Venous thromboembolism (VTE) remains a serious complication after the surgical treatment of breast cancer. Contemporary guidelines limit VTE chemoprophylaxis to the period of hospitalization. We conducted this study to evaluate the frequency of postdischarge VTE among surgically treated breast cancer patients and identify patient level factors associated with postdischarge VTE.
Using Arkansas, Florida, Nebraska, and New York state inpatient databases, we conducted a retrospective cohort study of adult women who underwent surgical treatment for breast cancer between October 1, 2008, and September 30, 2013. The primary outcome was a VTE event within 90 days of discharge. Multivariable logistic regression modeling was used to identify patient factors associated with VTE development.
The final sample included 52,547 women with most undergoing mastectomy without reconstruction (n = 25,665), followed by mastectomy with implant based reconstruction (n = 16,851), lumpectomy (n = 5319), and mastectomy with autologous reconstruction (n = 4622). There were 395 patients (0.8%) who developed at least 1 VTE. Of the 395 VTEs, 32.9% (n = 130) were identified before discharge, whereas 67.1% were identified within 90 days after discharge. Patients with respiratory disease (adjusted odds ratio [AOR] = 1.56 [1.22-1.98]), hypothyroidism (AOR = 1.31 [1.01-1.70]), a hospital stay of more than 5 days (AOR = 8.07 [5.99-10.89]), previous VTE (AOR = 6.26 [3.95-9.91]), or mastectomy with autologous reconstruction (AOR = 1.50 [1.03-2.19]) more frequently developed postdischarge VTEs.
Nearly two thirds of all 90-day VTE events after breast cancer surgery occur after discharge. Further research should determine whether a longer course of VTE prophylaxis is warranted among specific populations including those with prolonged hospitalizations, previous VTE, and those undergoing autologous reconstruction.
静脉血栓栓塞症（VTE）仍是乳腺癌手术治疗后的严重并发症。当代指南将VTE化学预防限制在住院期间。我们开展这项研究以评估接受手术治疗的乳腺癌患者出院后VTE的发生频率，并确定与出院后VTE相关的患者层面因素。
利用阿肯色州、佛罗里达州、内布拉斯加州和纽约州的住院患者数据库，我们对2008年10月1日至2013年9月30日期间接受乳腺癌手术治疗的成年女性进行了一项回顾性队列研究。主要结局是出院后90天内发生的VTE事件。采用多变量逻辑回归模型确定与VTE发生相关的患者因素。
最终样本包括52547名女性，大多数接受了未行重建的乳房切除术（n = 25665），其次是植入物重建的乳房切除术（n = 16851）、保乳手术（n = 5319）和自体组织重建的乳房切除术（n = 4622）。有395名患者（0.8%）发生了至少1次VTE。在这395次VTE中，32.9%（n = 130）在出院前被发现，而67.1%在出院后90天内被发现。患有呼吸系统疾病（调整后的优势比[AOR]=1.56[1.22 - 1.98]）、甲状腺功能减退（AOR = 1.31[1.01 - 1.70]）、住院时间超过5天（AOR = 8.07[5.99 - 10.89]）、既往有VTE（AOR = 6.26[3.95 - 9.91]）或自体组织重建的乳房切除术（AOR = 1.50[1.03 - 2.19]）的患者更常发生出院后VTE。
乳腺癌手术后90天内发生的所有VTE事件中，近三分之二发生在出院后。进一步的研究应确定在包括住院时间延长、既往有VTE以及接受自体组织重建的患者等特定人群中，是否需要更长疗程的VTE预防。
