Chen Qingshan, Cai YongSheng, Zhang Zhirong, Dong Honghong, Miao Jinbai, Li Hui, Hu Bin
Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Thromb J. 2022 Aug 1;20(1):43. doi: 10.1186/s12959-022-00402-1.
Venous thromboembolism (VTE) is a common postoperative complication in general thoracic surgery, but the incidence of patients undergoing surgery for bronchiectasis was not known. The purpose of our study was to investigate the incidence of VTE in bronchiectasis patients undergoing lung resection and to evaluate the risk stratification effect of the modified caprini risk assessment model (RAM).
We prospectively enrolled patients with bronchiectasis who underwent lung resection surgery between July 2016 and July 2020.The postoperative duplex lower-extremity ultrasonography or(and) computed tomographic pulmonary angiography (CTPA) was performed to detect VTE. The clinical characteristics and caprini scores of VTE patients and non-VTE patients would be compared and analyzed. Univariate logistic regression was performed to evaluate whether higher Caprini scores were associated with postoperative VTE risk.In addition, We explored the optimal cutoff for caprini score in patients with bronchiectasis by using the receiver operating characteristic (ROC) curve.
One hundred and seventeen patients were eligible based on the prospective study criteria. The postoperative VTE incidence was 8.5% (10/117). By comparing the clinical characteristics and Caprini scores of VTE and non-VTE patients, the median preoperative hospitalization (7 vs 5 days, P = 0.028) and Caprini score (6.5 vs 3,P < 0.001) were significantly higher in VTE patients. In univariate logistic regression, a higher Caprini score was associated with higher odds ratio (OR) for VTE of 1.7, 95% confidence interval (CI) was from 1.2 to 2.5 (P = 0.001), C-statistics was 0.815 in the modified caprini RAM for predicting VTE. In a multivariable analysis adjusting for preoperative hospitalization, a higher Caprini score was associated with higher odds OR for VTE of 1.8 (95%CI: 1.2-2.6, P = 0.002), C-statistics was 0.893 in the caprini RAM for predicting VTE. When taking the Caprini score as 5 points as the diagnostic threshold, the Youden index is the largest.
The postoperative VTE incidence in patients undergoing lung resection for bronchiectasis was 8.5%.The modified caprini RAM effectively stratified bronchiectasis surgery patients for risk of VTE and showed excellent predictive power for VTE. The patients with postoperative caprini scores = 5, should be recommended to take positive measures to prevent postoperative VTE.
Chinese Clinical Trial Register: ChiCTR-EOC-17010577.
静脉血栓栓塞症（VTE）是普通胸外科手术常见的术后并发症，但支气管扩张症手术患者的发病率尚不清楚。我们研究的目的是调查接受肺切除术的支气管扩张症患者VTE的发病率，并评估改良Caprini风险评估模型（RAM）的风险分层效果。
我们前瞻性纳入了2016年7月至2020年7月期间接受肺切除手术的支气管扩张症患者。术后进行双下肢超声检查或（和）计算机断层肺动脉造影（CTPA）以检测VTE。比较并分析VTE患者和非VTE患者的临床特征及Caprini评分。进行单因素逻辑回归分析以评估较高的Caprini评分是否与术后VTE风险相关。此外，我们通过绘制受试者工作特征（ROC）曲线探索支气管扩张症患者Caprini评分的最佳截断值。
根据前瞻性研究标准，117例患者符合条件。术后VTE发病率为8.5%（10/117）。通过比较VTE患者和非VTE患者的临床特征及Caprini评分，VTE患者术前中位住院时间（7天对5天，P = 0.028）和Caprini评分（6.5对3，P < 0.001）显著更高。在单因素逻辑回归中，较高的Caprini评分与VTE的较高比值比（OR）相关，为1.7，95%置信区间（CI）为1.2至2.5（P = 0.001），改良Caprini RAM预测VTE的C统计量为0.815。在对术前住院时间进行校正的多因素分析中，较高的Caprini评分与VTE的较高比值比OR相关，为1.8（95%CI：1.2 - 2.6，P = 0.002），Caprini RAM预测VTE的C统计量为0.893。以Caprini评分为5分作为诊断阈值时，约登指数最大。
支气管扩张症肺切除患者术后VTE发病率为8.5%。改良Caprini RAM有效地对支气管扩张症手术患者的VTE风险进行了分层，并对VTE显示出良好的预测能力。术后Caprini评分 = 5分的患者，建议采取积极措施预防术后VTE。
中国临床试验注册中心：ChiCTR - EOC - 17010577。
