Gastrointestinal Surgery, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), School of Medicine, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
Gastrointestinal and Liver Theme, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), School of Medicine, Queen's Medical Centre), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
Colorectal Dis. 2022 Nov;24(11):1405-1415. doi: 10.1111/codi.16233. Epub 2022 Jul 19.
It is important for patient safety to assess if international changes in perioperative care, such as the focus on venous thromboembolism (VTE) prevention and minimally invasive surgery, have reduced the high post colectomy VTE risks previously reported. This study assesses the impact of changes in perioperative care on VTE risk following colorectal resection.
This was a population-based cohort study of colectomy patients in England between 2000 and 2019 using a national database of linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Within 30 days following colectomy, absolute VTE rates per 1000 person-years and adjusted incidence rate ratios (aIRRs) using Poisson regression for the per year change in VTE risk were calculated.
Of 183 791 patients, 1337 (0.73%) developed 30-day postoperative VTE. Overall, VTE rates reduced over the 20-year study period following elective (relative risk reduction 31.25%, 95% CI 5.69%-49.88%) but not emergency surgery. Similarly, yearly changes in VTE risk reduced following minimally invasive resections (elective benign, aIRR 0.93, 95% CI 0.90-0.97; elective malignant, aIRR 0.94, 95% CI 0.91-0.98; and emergency benign, aIRR 0.96, 95% CI 0.92-1.00) but not following open resections. There was a per year VTE risk increase following open emergency malignant resections (aIRR 1.02, 95% CI 1.00-1.04).
Yearly VTE risks reduced following minimally invasive surgeries in the elective setting yet in contrast were static following open elective colectomies, and following emergency malignant resections increased by almost 2% per year. To reduce VTE risk, further efforts are required to implement advances in surgical care for those having emergency and/or open surgery.
评估围手术期护理的国际变化（如静脉血栓栓塞症[VTE]预防和微创手术的关注）是否降低了先前报道的高结肠切除术后 VTE 风险，这对于患者安全很重要。本研究评估了围手术期护理变化对结直肠切除术后 VTE 风险的影响。
这是一项基于人群的队列研究，纳入了 2000 年至 2019 年期间在英格兰接受结直肠切除术的患者，使用全国性的初级（临床实践研究数据链接）和二级（医院发病统计）护理数据链接数据库。在结直肠切除术后 30 天内，计算每 1000 人年的绝对 VTE 发生率和使用泊松回归计算的每 1 年 VTE 风险变化的调整发病率比（aIRR）。
在 183791 名患者中，有 1337 名（0.73%）发生了 30 天术后 VTE。总体而言，在 20 年的研究期间，择期手术（相对风险降低 31.25%，95%CI 5.69%-49.88%）而非急诊手术的 VTE 发生率降低。同样，微创切除术后 VTE 风险的年变化减少（择期良性，aIRR 0.93，95%CI 0.90-0.97；择期恶性，aIRR 0.94，95%CI 0.91-0.98；急诊良性，aIRR 0.96，95%CI 0.92-1.00），但开放切除术后未见减少。开放急诊恶性切除术后每年 VTE 风险增加（aIRR 1.02，95%CI 1.00-1.04）。
择期微创手术中，VTE 风险逐年降低，但与之相反的是，开放性择期结直肠切除术的 VTE 风险保持不变，而急诊恶性切除术的 VTE 风险每年增加近 2%。为了降低 VTE 风险，需要进一步努力将手术护理的进展应用于接受急诊和/或开放性手术的患者。
