Gastrointestinal Surgery, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, School of Medicine, Queen's Medical Centre, Nottingham, UK.
Gastrointestinal and Liver Theme, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, School of Medicine, Queen's Medical Centre, Nottingham, UK.
Ann Surg. 2022 Sep 1;276(3):e177-e184. doi: 10.1097/SLA.0000000000005563. Epub 2022 Jul 19.
To assess the impact of current guidelines by reporting weekly postoperative postdischarge venous thromboembolism (VTE) rates.
Disparity exists between the postoperative thromboprophylaxis duration colectomy patients receive based on surgical indication, where malignant resections routinely receive 28 days extended thromboprophylaxis into the postdischarge period and benign resections do not.
English national cohort study of colectomy patients between 2010 and 2019 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care data. Stratified by admission type and surgical indication, absolute incidence rates (IRs) per 1000 person-years and adjusted incidence rate ratios (aIRRs) for postdischarge VTE were calculated for the first 4 weeks following resection and postdischarge VTE IRs for each postoperative week to 12 weeks postoperative.
Of 104,744 patients, 663 (0.63%) developed postdischarge VTE within 12 weeks after colectomy. Postdischarge VTE IRs per 1000 person-years for the first 4 weeks postoperative were low following elective resections [benign: 20.66, 95% confidence interval (CI): 13.73-31.08; malignant: 28.95, 95% CI: 23.09-36.31] and higher following emergency resections (benign: 47.31, 95% CI: 34.43-65.02; malignant: 107.18, 95% CI: 78.62-146.12). Compared with elective malignant resections, there was no difference in postdischarge VTE risk within 4 weeks following elective benign colectomy (aIRR=0.92, 95% CI: 0.56-1.50). However, postdischarge VTE risks within 4 weeks following emergency resections were significantly greater for benign (aIRR=1.89, 95% CI: 1.22-2.94) and malignant (aIRR=3.13, 95% CI: 2.06-4.76) indications compared with elective malignant colectomy.
Postdischarge VTE risk within 4 weeks of colectomy is ∼2-fold greater following emergency benign compared with elective malignant resections, suggesting emergency benign colectomy patients may benefit from extended VTE prophylaxis.
通过报告每周术后出院后静脉血栓栓塞症（VTE）的发生率，评估当前指南的影响。
根据手术指征，接受结直肠切除术的患者接受的术后抗血栓形成治疗持续时间存在差异，其中恶性切除术常规接受 28 天的延长抗血栓形成治疗进入出院后阶段，而良性切除术则没有。
这是一项 2010 年至 2019 年期间使用链接的初级（临床实践研究数据链接）和二级（医院入院统计）护理数据的英国队列研究，对入组类型和手术指征进行分层，计算术后第 1 至 4 周的绝对发病率（IR）和出院后 VTE 的调整发病率比（aIRR），以及术后第 1 至 12 周的每个术后周的出院后 VTE IR。
在 104744 名患者中，663 名（0.63%）在结直肠切除术后 12 周内发生了出院后 VTE。术后第 1 至 4 周的出院后 VTE IRs 在择期切除术后较低[良性：20.66，95%置信区间（CI）：13.73-31.08；恶性：28.95，95%CI：23.09-36.31]，在急诊切除术后较高[良性：47.31，95%CI：34.43-65.02；恶性：107.18，95%CI：78.62-146.12]。与择期恶性切除术相比，择期良性结直肠切除术在 4 周内出院后 VTE 风险没有差异（aIRR=0.92，95%CI：0.56-1.50）。然而，急诊切除术后 4 周内，良性（aIRR=1.89，95%CI：1.22-2.94）和恶性（aIRR=3.13，95%CI：2.06-4.76）指征的出院后 VTE 风险明显高于择期恶性切除术。
与择期恶性切除术相比，急诊良性切除术患者在术后 4 周内的出院后 VTE 风险增加了近 2 倍，这表明急诊良性切除术患者可能受益于延长 VTE 预防治疗。
