Department of Surgery, James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
J Gastrointest Surg. 2021 Dec;25(12):3064-3073. doi: 10.1007/s11605-021-05080-4. Epub 2021 Jul 19.
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a common cause of morbidity and mortality following complex gastrointestinal surgery. Whether perioperative VTE also exposes patients to a higher long-term risk of VTE events remains poorly defined.
The Medicare 100% Standard Analytic Files were used to identify patients undergoing esophageal, hepatic, pancreatic, and colorectal resection between 2013 and 2017. The impact of perioperative VTE, defined as a VTE episode occurring during the index hospitalization or within 30 days of discharge, on the risk of developing subsequent long-term VTE episodes (i.e., more than 30 days following discharge) was examined.
Among 253,212 patients who underwent complex gastrointestinal surgery, 1.9% (n=4763) developed a VTE episode perioperatively. With a median follow-up period of 553 days (IQR 194-1052), a total of 11,052 patients (4.4%) developed a long-term VTE episode. Of note, patients who developed a DVT perioperatively had a higher risk of experiencing a long-term VTE episode than patients who had no perioperative thromboembolic complications (HR 6.50, 95%CI 6.04-6.98). The increase in risk was more pronounced among patients who had a PE (HR 27.97, 95%CI 25.39-30.80) at the time of surgery. Risk factors for long-term thromboembolic events following complex GI surgery included Black patients (HR 1.20, 95%CI 1.11-1.30), receipt of surgery at a teaching hospital (HR 1.09, 95%CI 1.04-1.13), nonelective surgery (HR 1.19, 95%CI 1.14-1.24), as well as a diagnosis of cancer (HR 1.10, 95%CI 1.05-1.16). The development of a perioperative DVT was associated with an increased long-term risk of VTE in both cancer (HR 5.59, 95%CI 5.29-6.61) and non-cancer patients (HR 6.98, 95%CI 6.37-7.64). Similarly, experiencing a PE at the time of surgery led to a higher long-term risk of VTE in cancer (HR 24.30, 95%CI 21.08-28.02), as well as non-cancer (HR 30.81, 95%CI 27.01-35.15) patients.
Patients with a history of perioperative VTE had a higher risk of developing subsequent VTE events within 1-2 years following complex GI surgery. The risk was more pronounced among patients who had perioperative PE rather than DVT. These findings were consistent among both cancer and non-cancer patients.
静脉血栓栓塞症（VTE），包括深静脉血栓形成（DVT）和肺栓塞（PE），是复杂胃肠手术后发病率和死亡率升高的常见原因。术后 VTE 是否使患者面临更高的长期 VTE 事件风险仍不清楚。
使用 Medicare 100%标准分析文件确定 2013 年至 2017 年间接受食管、肝、胰腺和结直肠切除术的患者。研究了围手术期 VTE（定义为住院期间或出院后 30 天内发生的 VTE 发作）对随后发生长期 VTE 发作（即出院后 30 天以上）的风险的影响。
在接受复杂胃肠手术的 253212 名患者中，1.9%（n=4763）发生围手术期 VTE 发作。中位随访期为 553 天（IQR 194-1052），共有 11052 名患者（4.4%）发生长期 VTE 发作。值得注意的是，与无围手术期血栓栓塞并发症的患者相比，发生围手术期 DVT 的患者发生长期 VTE 发作的风险更高（HR 6.50，95%CI 6.04-6.98）。对于在手术时发生 PE 的患者，风险增加更为明显（HR 27.97，95%CI 25.39-30.80）。复杂胃肠手术后发生长期血栓栓塞事件的危险因素包括黑人患者（HR 1.20，95%CI 1.11-1.30）、在教学医院接受手术（HR 1.09，95%CI 1.04-1.13）、非择期手术（HR 1.19，95%CI 1.14-1.24）和癌症诊断（HR 1.10，95%CI 1.05-1.16）。围手术期 DVT 的发生与癌症（HR 5.59，95%CI 5.29-6.61）和非癌症患者（HR 6.98，95%CI 6.37-7.64）的长期 VTE 风险增加相关。同样，在手术时发生 PE 导致癌症（HR 24.30，95%CI 21.08-28.02）和非癌症（HR 30.81，95%CI 27.01-35.15）患者的长期 VTE 风险更高。
有围手术期 VTE 病史的患者在接受复杂胃肠手术后 1-2 年内发生后续 VTE 事件的风险较高。在有围手术期 PE 而不是 DVT 的患者中，风险更为明显。这些发现在癌症和非癌症患者中均一致。
