Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada.
Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Tech Coloproctol. 2018 Dec;22(12):955-964. doi: 10.1007/s10151-018-1909-8. Epub 2018 Dec 19.
Extended thromboprophylaxis after abdominal and pelvic cancer surgery to prevent venous thromboembolic events (VTE) is recommended but adherence is sub-optimal. Identifying patients at highest risk for post-discharge events may allow for selective extended thromboprophylaxis. The aim of our study was to identify the different risk factors of venous thromboembolism for in-hospital and post-discharge events.
The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2012-2016 database was queried for all patients having colorectal resection. Primary outcome was postoperative VTE occurrence within 30 days. A multinomial logistic regression was performed to identify in-hospital and post-discharge predictors of VTE, adjusting for potential confounders.
Out of 260,258 patients, 5381 (2.1%) developed VTE. A total of 3442 (1.3%) were diagnosed during the initial hospital stay and 1929 (0.8%) post-discharge. Risk factors for in-hospital and post-discharge VTE were different as patients with an in-hospital event were more likely to be older, male, known for preoperative steroid use, have poor functional status, significant weight loss, preoperative sepsis, prolonged operative time, undergoing an emergency operation. In the post-discharge setting, steroid use, poor functional status, preoperative sepsis, and postoperative complications remained significant. Postoperative complications were the strongest predictor of in-hospital and post-discharge VTE. Patients with inflammatory bowel disease had a higher risk of VTE than patients with malignancy for both in-patient and post-discharge events.
Patients at high-risk for post-discharge events have different characteristics than those who develop VTE in-hospital. Identifying this specific subset of patients at highest risk for post-discharge VTE may allow for the selective use of prolonged thromboprophylaxis.
腹部和骨盆癌症手术后延长血栓预防以预防静脉血栓栓塞事件（VTE）是推荐的，但依从性不理想。确定发生出院后事件风险最高的患者可能允许选择性延长血栓预防。我们研究的目的是确定住院期间和出院后静脉血栓栓塞事件的不同危险因素。
美国外科医师学院-国家外科质量改进计划（ACS-NSQIP）2012-2016 数据库对所有接受结直肠切除术的患者进行了查询。主要结局是术后 30 天内发生静脉血栓栓塞事件。采用多变量逻辑回归分析确定住院和出院后 VTE 的预测因素，并调整潜在混杂因素。
在 260258 例患者中，5381 例（2.1%）发生 VTE。共有 3442 例（1.3%）在初次住院期间诊断，1929 例（0.8%）在出院后诊断。住院和出院后 VTE 的危险因素不同，因为住院期间发生 VTE 的患者更可能年龄较大、男性、术前已知使用类固醇、功能状态差、显著体重减轻、术前败血症、手术时间延长、急诊手术。在出院后环境中，类固醇使用、功能状态差、术前败血症和术后并发症仍然是显著的。术后并发症是住院和出院后 VTE 的最强预测因素。与恶性肿瘤患者相比，炎症性肠病患者在住院和出院后事件中发生 VTE 的风险更高。
有出院后事件高风险的患者与在医院内发生 VTE 的患者有不同的特征。确定出院后 VTE 风险最高的这一特定亚组患者可能允许选择性使用延长的血栓预防。
