预测择期脾切除术患者的静脉血栓形成。
Predicting venous thrombosis in patients undergoing elective splenectomy.
机构信息
Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
Division of General and Gastrointestinal Surgery, Brigham and Women's Hospital, 75 Francis Street, ASBII-3rd Floor, Boston, MA, 02115, USA.
出版信息
Surg Endosc. 2020 May;34(5):2191-2196. doi: 10.1007/s00464-019-07007-2. Epub 2019 Jul 29.
BACKGROUND
Venous thrombosis (VT) is an ongoing problem for patients undergoing elective splenectomy. There is limited data evaluating risk factors for VTs. An increase in platelet counts is commonly seen after splenectomy; however, there is a paucity of literature evaluating post-operative platelet counts as a risk factor for VTs in this patient cohort. The objective of this study was to determine the incidence of VT events and to use the platelet count as a predictor for VT development.
METHODS
A retrospective review was undertaken at Brigham Women's Hospital, evaluating elective splenectomy patients between 1997 and 2018. Descriptive statistics were utilized to determine the incidence of VTs. Receiver operator characteristic (ROC) curves were utilized to identify platelet counts that could predict VTs.
RESULTS
Five hundred and twenty splenectomies were included in the study of which 344 were completed in an open manner and 176 were done laparoscopically. The overall incidence of VT events was 6.7% (35/520), 6.1% (21/344) for open, and 8.0% (14/176) for laparoscopic approaches (p = 0.43). ROC curves demonstrated platelet counts to be a good predictor for the development of VTs with an area under the curve (AUC) of 0.77 (95% CI 0.69-0.86; p < 0.001) for all splenectomy patients, 0.70 (95% CI 0.59-0.81; p < 0.001) for those completed in an open manner, and 0.88 (95% CI 0.77-0.99; p < 0.001) for those done laparoscopically. The optimal platelet cutoff was found to be 545 for the overall splenectomy cohort, 457 for the open, and 659 for the laparoscopic cohorts. These platelet counts had a diagnostic accuracy that ranged from 61 to 86% and a negative predictive value (NPV) that ranged from 97 to 99%.
CONCLUSION
These results suggest platelet cutoffs that predict VTs. This information can be used to individualize prophylactic strategies.
背景
静脉血栓形成（VT）是择期脾切除术患者面临的一个持续存在的问题。目前评估 VT 风险因素的数据有限。脾切除术后血小板计数通常会升高；然而，在这一患者群体中，术后血小板计数作为 VT 发生的危险因素的文献却很少。本研究的目的是确定 VT 事件的发生率，并使用血小板计数作为 VT 发生的预测指标。
方法
本研究对 1997 年至 2018 年在布莱根妇女医院接受择期脾切除术的患者进行了回顾性研究。采用描述性统计方法确定 VT 事件的发生率。利用接收者操作特征（ROC）曲线确定可预测 VT 的血小板计数。
结果
本研究共纳入 520 例脾切除术患者，其中 344 例采用开放性手术完成，176 例采用腹腔镜手术完成。VT 事件的总发生率为 6.7%（35/520），开放性手术组为 6.1%（21/344），腹腔镜手术组为 8.0%（14/176）（p=0.43）。ROC 曲线表明，血小板计数是预测 VT 发生的一个较好的指标，曲线下面积（AUC）为 0.77（95%CI 0.69-0.86；p<0.001），适用于所有脾切除术患者；0.70（95%CI 0.59-0.81；p<0.001），适用于开放性手术患者；0.88（95%CI 0.77-0.99；p<0.001），适用于腹腔镜手术患者。发现总体脾切除术患者的最佳血小板截止值为 545，开放性手术为 457，腹腔镜手术为 659。这些血小板计数的诊断准确性为 61%至 86%，阴性预测值（NPV）为 97%至 99%。
结论
这些结果提示了预测 VT 的血小板截止值。这些信息可用于个体化预防策略。
Zotero 插件