Pohl Abigail, Spaulding Aaron C, Brennan Emily R, Stauffer John, Hussain Walid Akram, Muraleedharan Divya, Colibaseanu Dorin T, Edwards Michael A
Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic Alix School of Medicine Consultant, Mayo Clinic, 4500 San Pablo Rd S Davis Building, 3 North, 32224, Jacksonville, FL, USA.
Robert D. and Patricia E. Kern Center, Division of Health Care Delivery Research Jacksonville, Mayo Clinic, 32224, Jacksonville, FL, USA.
J Thromb Thrombolysis. 2023 May;55(4):604-616. doi: 10.1007/s11239-023-02775-0. Epub 2023 Jan 25.
This study analyzes pancreatectomy cases performed between 2016 and 2021 to determine the impact of using Caprini guideline indicated VTE prophylaxis on VTE and bleeding complications. This is a retrospective study of cases performed in a single academic health care system, in which Caprini score and VTE prevention measures were determined retroactively and prevention practices binarized as appropriate or not appropriate. Univariate and multivariate analyses were performed of 1,299 pancreatectomy case. Most patients were stratified as high risk for postoperative VTE. Receiving appropriate VTE prophylaxis during admission was associated with a 3-fold reduction in VTE complications (0.82% vs. 2.64%, p=0.01) without increasing bleeding complications. All VTE complications occurring with 30-day (1.2%) and 90-day (2.7%) from hospital discharged occurred in those not receiving appropriate prophylaxis, and discharged bleeding complications were also not associated with receivng appropriate discharged VTE prophylaxis. The findings our the study are significant as it highlights the ongoing need for standardization in VTE risk assessment and prevention measures to increase compliance to risk adjusted VTE prevention practice guidelines, thus reducing preventable VTE complications and potentially associated morbidity and mortality.
本研究分析了2016年至2021年间进行的胰腺切除术病例,以确定使用Caprini指南推荐的静脉血栓栓塞(VTE)预防措施对VTE和出血并发症的影响。这是一项对在单一学术医疗系统中进行的病例的回顾性研究,其中Caprini评分和VTE预防措施是追溯确定的,预防措施按适当或不适当进行二元化处理。对1299例胰腺切除术病例进行了单因素和多因素分析。大多数患者被分层为术后VTE高危。入院期间接受适当的VTE预防与VTE并发症减少3倍相关(0.82%对2.64%,p=0.01),且不增加出血并发症。所有在出院后30天(1.2%)和90天(2.7%)发生的VTE并发症均发生在未接受适当预防的患者中,出院时的出血并发症也与接受适当的出院VTE预防无关。本研究的结果具有重要意义,因为它突出了持续需要在VTE风险评估和预防措施方面实现标准化,以提高对风险调整后的VTE预防实践指南的依从性,从而减少可预防的VTE并发症以及潜在的相关发病率和死亡率。