Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Ann Surg Oncol. 2018 Nov;25(12):3548-3555. doi: 10.1245/s10434-018-6696-y. Epub 2018 Aug 20.
Guidelines for venous thromboembolism (VTE) prophylaxis are not well-established for breast surgery patients. An individualized VTE prophylaxis protocol using the Caprini score was adopted at our institution for patients undergoing mastectomy ± implant-based reconstruction. In this study, we report our experience during the first year of implementation.
In August 2016, we adopted a VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction. We used the Caprini score, a validated risk assessment tool for VTE, to determine each patient's perioperative prophylaxis regimen. Detailed chart review was performed to record patient and treatment details, the Caprini score, pharmacologic VTE prophylaxis administration, and 30-day incidence of VTE and bleeding complications. We performed univariate analysis to identify factors associated with protocol compliance.
Overall, 522 patients met the inclusion criteria. Median age was 51 years, 486 (93.1%) patients had malignancy, 234 (44.8%) underwent bilateral mastectomy, and 350 (67.0%) underwent reconstruction. Caprini scores ranged from 2 to 11, with 431 (82.6%) patients having a score from 5 to 7. Overall protocol compliance was 60.5%, and was associated with bilateral mastectomy (p = 0.02), reconstruction (p = 0.03), and longer procedures (p < 0.001). The rate of VTE was 0.2% (95% confidence interval [CI] 0.03-1.1%), rate of reoperation for hematoma was 2.7% (95% CI 1.6-4.5%), and rate of blood transfusion was 0.4% (95% CI 0.1-1.4%).
The implementation of an individualized VTE prophylaxis protocol for patients undergoing mastectomy ± implant-based reconstruction is safe and feasible. Despite a high-risk cohort, the incidence of VTE was very low and bleeding complications were consistent with reported rates for breast surgery. Continued evaluation of this strategy is warranted.
针对乳腺癌手术患者，静脉血栓栓塞症（VTE）预防的指南尚未完善。在我们机构，针对接受乳房切除术+植入物重建的患者，采用了一种基于卡普里尼评分的个体化 VTE 预防方案。在这项研究中，我们报告了实施的第一年的经验。
2016 年 8 月，我们为接受乳房切除术+植入物重建的患者采用了 VTE 预防方案。我们使用卡普里尼评分，这是一种经过验证的 VTE 风险评估工具，来确定每个患者的围手术期预防方案。详细的图表审查记录了患者和治疗细节、卡普里尼评分、药物 VTE 预防管理以及 30 天内 VTE 和出血并发症的发生率。我们进行了单变量分析，以确定与方案遵守相关的因素。
总体而言，522 名患者符合纳入标准。中位年龄为 51 岁，486 名（93.1%）患者患有恶性肿瘤，234 名（44.8%）接受了双侧乳房切除术，350 名（67.0%）接受了重建。卡普里尼评分为 2-11 分，431 名（82.6%）患者评分为 5-7 分。总体方案遵守率为 60.5%，与双侧乳房切除术（p=0.02）、重建（p=0.03）和较长的手术时间（p<0.001）相关。VTE 的发生率为 0.2%（95%置信区间 [CI] 0.03-1.1%），血肿再次手术率为 2.7%（95% CI 1.6-4.5%），输血率为 0.4%（95% CI 0.1-1.4%）。
为接受乳房切除术+植入物重建的患者实施个体化 VTE 预防方案是安全可行的。尽管患者为高危人群，但 VTE 的发生率非常低，出血并发症与乳房手术的报告发生率一致。需要继续评估这种策略。
