Department of Surgery, Division of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Biostatistics Core, Samuel Oschin Comprehensive Cancer Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Ann Surg Oncol. 2018 Jun;25(6):1640-1645. doi: 10.1245/s10434-018-6461-2. Epub 2018 Apr 6.
Postoperative venous thromboembolism (VTE) is a leading cause of in-hospital mortality for cancer patients; however, the prevalence of preoperative VTE remains unclear.
The aim of this study was to evaluate the prevalence and risk factors associated with preoperative VTE in asymptomatic patients undergoing major oncologic surgery.
Retrospective analysis of 346 patients identified from our prospectively maintained database of patients undergoing abdominopelvic oncologic surgery from 2009 to 2016.
The prevalence of preoperative VTE found on screening venous duplex scan was 10.1%. Patients with a history of prior VTE were more likely to have a preoperative deep vein thrombosis (DVT) versus those with no prior VTE (42.9% vs. 4.5%, p < 0.01). Relative risk for prior VTE was 8.2 [95% confidence interval (CI) 4.7-14.3]. Older age was also associated with preoperative VTE. Regression modeling determined that patients were 1.24-fold as likely to have a preoperative DVT for every 5-year increase in age (relative risk 1.24, 95% CI 1.09-1.42). Patients with preoperative DVT were more likely to have been diagnosed with sepsis 1 month prior to surgery (8.6% vs. 1.6%, p = 0.04). There were no postoperative pulmonary emboli. The overall postoperative complication rate was higher in those with a preoperative DVT (25.7% vs. 13.2%, p = 0.071).
Asymptomatic patients undergoing major oncologic surgery have a 10.1% prevalence of preoperative DVT. Increasing age, recent diagnosis of sepsis, and a history of prior VTE are significantly associated with preoperative DVTs. This suggests high-risk oncologic patients may benefit from screening lower extremity venous duplex ultrasound prior to Surgery.
术后静脉血栓栓塞症（VTE）是癌症患者住院死亡的主要原因；然而，术前 VTE 的患病率尚不清楚。
本研究旨在评估无症状接受大型肿瘤手术的患者术前 VTE 的患病率和相关危险因素。
回顾性分析了 2009 年至 2016 年期间从我们前瞻性维持的接受腹盆部肿瘤手术的患者数据库中确定的 346 例患者。
在筛选性静脉双功超声检查中发现术前 VTE 的患病率为 10.1%。有 VTE 病史的患者比无 VTE 病史的患者更有可能发生术前深静脉血栓形成（DVT）（42.9% vs. 4.5%，p<0.01）。VTE 病史的相对风险为 8.2（95%可信区间[CI] 4.7-14.3）。年龄较大也与术前 VTE 相关。回归模型确定，患者每增加 5 岁，发生术前 DVT 的可能性就增加 1.24 倍（相对风险 1.24，95%CI 1.09-1.42）。术前有 DVT 的患者更有可能在手术前 1 个月被诊断为败血症（8.6% vs. 1.6%，p=0.04）。无术后肺栓塞。术前 DVT 患者的术后总并发症发生率较高（25.7% vs. 13.2%，p=0.071）。
接受大型肿瘤手术的无症状患者术前 DVT 的患病率为 10.1%。年龄增长、近期败血症诊断和 VTE 病史与术前 DVT 显著相关。这表明，高危肿瘤患者可能受益于在手术前进行下肢静脉双功超声筛查。
