PROTECTinG investigators are co-authors of this study and are listed in the Supplementary Appendix S1.
Division of Surgery, Anaesthesia and Procedural Medicine, Austin Hospital, Heidelberg, Victoria, Australia.
Surgery. 2022 Jul;172(1):198-204. doi: 10.1016/j.surg.2022.01.023. Epub 2022 Mar 2.
Major ventral hernia surgeries are commonly performed. Despite guideline recommendations for chemo-thromboprophylaxis in the perioperative period, the optimal timing for its initiation is unknown. We characterized the variability in perioperative chemoprophylaxis in elective major ventral hernia surgery and determine whether timing of chemoprophylaxis affects bleeding and symptomatic venous thromboembolism.
Retrospective analysis of all elective major ventral hernia surgery undertaken between January 1, 2014, and December 31, 2019, at 14 hospitals across Australia. Major bleeding was defined as the need for blood transfusion, reoperation, or >20 g/L fall in hemoglobin. Clinical venous thromboembolism was defined as imaging-proven symptomatic disease <30 days postsurgery. Propensity score matched analysis was used to validate primary findings.
In the study, 3,384 hernia repairs were analyzed. Chemoprophylaxis was administered early (before skin closure), postoperatively, or not given in 856 (25.3%), 1,701 (50.3%), and 827 (24.4%) patients, respectively. This varied between surgeons, trainees, and institutions. Clinical venous thromboembolism occurred in 6 (0.2%) patients and was unrelated to chemoprophylaxis timing. 134 (4.0%) patients had postoperative bleeding, with 67 (50%) major bleeds, requiring surgical control in 41 (30.6%) cases. Bleeding extended duration of stay (mean [standard deviation], 7.0 (13.9) vs 2.6 (4.7) days, P < .001). Notably, compared with postoperative (odds ratio 1.98; 95% confidence interval, 1.36-2.88; P < .001) and no (odds ratio 2.83; 95% confidence interval, 1.70-4.89; P < .001) chemoprophylaxis, early initiation significantly increased bleeding risk and independently predicted its occurrence.
The incidence of clinical venous thromboembolism after elective major ventral hernia repair is low. Variability in perioperative thromboprophylaxis is high. Early chemoprophylaxis increases bleeding risk without appreciable additional protection from venous thromboembolism.
大型腹侧疝手术通常进行。尽管指南建议围手术期进行化疗-血栓预防，但启动的最佳时机尚不清楚。我们描述了择期大型腹侧疝手术中围手术期化学预防的变异性，并确定化学预防的时机是否会影响出血和症状性静脉血栓栓塞。
对 2014 年 1 月 1 日至 2019 年 12 月 31 日期间在澳大利亚 14 家医院进行的所有择期大型腹侧疝手术进行回顾性分析。主要出血定义为需要输血、再次手术或血红蛋白下降>20 g/L。临床静脉血栓栓塞定义为手术后 30 天内有影像学证实的症状性疾病。使用倾向评分匹配分析验证主要发现。
在这项研究中，分析了 3384 例疝修补术。分别有 856 例（25.3%）、1701 例（50.3%）和 827 例（24.4%）患者在早期（皮肤闭合前）、术后或未给予化学预防。这种情况在外科医生、受训者和机构之间有所不同。发生了 6 例（0.2%）患者的临床静脉血栓栓塞，与化学预防时机无关。134 例（4.0%）患者发生术后出血，其中 67 例（50%）为主要出血，41 例（30.6%）需要手术控制。出血延长了住院时间（平均[标准差]，7.0[13.9] vs 2.6[4.7]天，P<.001）。值得注意的是，与术后（比值比 1.98；95%置信区间，1.36-2.88；P<.001）和无（比值比 2.83；95%置信区间，1.70-4.89；P<.001）化学预防相比，早期启动显著增加了出血风险，并独立预测了出血的发生。
择期大型腹侧疝修复术后临床静脉血栓栓塞的发生率较低。围手术期血栓预防的变异性很高。早期化学预防增加了出血风险，但对静脉血栓栓塞没有明显的额外保护作用。
