Tian Bo, Li Hui, Cui Songping, Song Chunfeng, Li Tong, Hu Bin
Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
J Thorac Dis. 2019 May;11(5):1903-1910. doi: 10.21037/jtd.2019.05.11.
Venous thromboembolism (VTE) is an insidious disease with significant morbidity and mortality. We conducted a retrospective single-center study on patients who underwent thoracic surgery and developed a novel VTE risk assessment model (RAM).
Patients who underwent thoracic surgery between July 2016 and December 2017 (n=533) at the Beijing Chao-Yang Hospital were enrolled in this study. None of the patients received any prophylaxis perioperatively. Lower limbs Doppler ultrasonography was performed before and after surgery for deep venous thrombosis (DVT) confirmation. Patients with new postoperative DVT, typical symptoms of pulmonary embolism (PE), or high Caprini score (≥9) underwent further computer tomography pulmonary angiography (CTPA) examination for PE. Caprini, Rogers, Padua, and Khorana RAM were used for all of the patients. A novel RAM of VTE, which we called Chao-Yang VTE RAM, was developed according to the logistic regression analysis.
The overall incidence of VTE after thoracic surgery was 8.4% (45 of 533). Among the 45 VTE patients, 86.7% have DVT and 13.3% have DVT + PE. Age ≥60 (OR 4.51, 95% CI: 2.09-9.71, P=0.000) has an independent risk factor for VTE. The areas under the receiver operating characteristic (ROC) curve of Caprini, Rogers, Padua, Khorana, and Chao-Yang models were 0.74 (P<0.0001), 0.52 (P=0.62), 0.69 (P<0.0001), 0.64 (P=0.0017), and 0.80 (P<0.0001), respectively. The VTE incidence in the low-, moderate-, and high-risk groups predicted with Chao-Yang scores was 1.3% (3 of 230), 8.4% (14 of 166), and 20.4% (28 of 137); these were 1.6% (3 of 192), 11.9% (38 of 318), and 17.4% (4 of 23), respectively, when using the Caprini criteria. The high-risk group had a significantly higher incidence than the low- and moderate-risk groups (P=0.000). Additionally, as the number of risk factors increased, the incidence of VTE increased from 1.2% to 50.0%.
The incidence of VTE in patients who underwent major thoracic surgery was high in our series. Based on a retrospective single-center population study, we developed a novel prediction model to identify patients receiving thoracic surgery with different risks for VTE events.
静脉血栓栓塞症（VTE）是一种隐匿性疾病，具有较高的发病率和死亡率。我们对接受胸外科手术的患者进行了一项回顾性单中心研究，并开发了一种新型VTE风险评估模型（RAM）。
本研究纳入了2016年7月至2017年12月在北京朝阳医院接受胸外科手术的患者（n = 533）。所有患者围手术期均未接受任何预防措施。术前和术后均行下肢多普勒超声检查以确诊深静脉血栓形成（DVT）。术后新发DVT、有肺栓塞（PE）典型症状或Caprini评分高（≥9分）的患者接受进一步的计算机断层扫描肺动脉造影（CTPA）检查以排除PE。所有患者均使用Caprini、Rogers、Padua和Khorana风险评估模型。根据逻辑回归分析开发了一种新型的VTE风险评估模型，我们称之为朝阳VTE RAM。
胸外科手术后VTE的总体发生率为8.4%（533例中的45例）。在45例VTE患者中，86.7%患有DVT，13.3%患有DVT + PE。年龄≥60岁（OR 4.51，95%CI：2.09 - 9.71，P = 0.000）是VTE的独立危险因素。Caprini、Rogers、Padua、Khorana和朝阳模型的受试者工作特征（ROC）曲线下面积分别为0.74（P < 0.0001）、0.52（P = 0.62）、0.69（P < 0.0001）、0.64（P = 0.0017）和0.80（P < 0.0001）。根据朝阳评分预测的低、中、高风险组VTE发生率分别为1.3%（230例中的3例）、8.4%（166例中的14例）和20.4%（137例中的28例）；使用Caprini标准时，分别为1.6%（192例中的3例）、11.9%（318例中的38例）和17.4%（23例中的4例）。高风险组的发生率显著高于低风险组和中风险组（P = 0.000）。此外，随着危险因素数量的增加，VTE的发生率从1.2%增加到50.0%。
在我们的系列研究中，接受大型胸外科手术患者的VTE发生率较高。基于一项回顾性单中心人群研究，我们开发了一种新型预测模型，以识别接受胸外科手术且发生VTE事件风险不同的患者。
