Edwards Michael A, Hussain Md Walid Akram, Spaulding Aaron C, Brennan Emily, Bowers Steven P, Elli Enrique Fernando, Thomas Mathew
Division of Advanced GI and Bariatric Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA.
Department Surgery, Mayo Clinic Alix School of Medicine, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA.
J Gastrointest Surg. 2023 Oct;27(10):2045-2056. doi: 10.1007/s11605-023-05815-5. Epub 2023 Sep 5.
Venous thromboembolism (VTE) occurs in 3-11% of esophagectomy patients and is associated with increased mortality and morbidity. The use of validated VTE risk assessment tools and compliance with recommended practice guidelines remains unclear. In this study, we seek to determine the use of Caprini guideline indicated VTE prophylaxis and its effect on VTE and bleeding complications following esophagectomy.
Esophagectomy cases were identified from the Mayo Clinic electronic health records. Caprini score and VTE prophylaxis regimen received were determined retrospectively. VTE prophylaxis was identified as appropriate or inappropriate based on the Caprini score and prophylaxis received preoperative, during hospitalization, and after hospital discharge. Study cohorts were compared by Pearson Chi-square test, Fisher's Exact test, Kruskal-Wallis test, and logistic regression models. Stata/MP 16.1 was used for analysis. Odds ratios and 95% confidence intervals were reported for logistic regression models. A p-value < 0.05 was considered significant.
Four hundred and fifty-six esophagectomy cases were analyzed. The median Caprini score was thirteen. Appropriate prophylaxis resulted in a 6.9-fold reduction in inpatient VTE. All 30- and 90-day post-discharge VTEs occurred in those not receiving Caprini guideline-indicated VTE prophylaxis. Inpatient, 30- and 90-day post-discharge bleeding rates were 7.68%, 0.91%, and 2.11%, respectively; however, bleeding was not increased with receipt of appropriate prophylaxis.
In this esophagectomy cohort, Caprini guideline indicated VTE prophylaxis resulted in reduced inpatient VTE events without increasing bleeding complications. Risk-based VTE prevention measures should be considered in this patient cohort known to be at heightened risk for postoperative VTE.
静脉血栓栓塞症（VTE）在3%至11%的食管癌切除患者中发生，且与死亡率和发病率增加相关。使用经过验证的VTE风险评估工具以及遵循推荐的实践指南情况仍不明确。在本研究中，我们试图确定使用Caprini指南推荐的VTE预防措施及其对食管癌切除术后VTE和出血并发症的影响。
从梅奥诊所电子健康记录中识别出食管癌切除病例。回顾性确定Caprini评分和接受的VTE预防方案。根据Caprini评分以及术前、住院期间和出院后接受的预防措施，将VTE预防措施确定为适当或不适当。通过Pearson卡方检验、Fisher精确检验、Kruskal-Wallis检验和逻辑回归模型对研究队列进行比较。使用Stata/MP 16.1进行分析。逻辑回归模型报告比值比和95%置信区间。p值<0.05被认为具有统计学意义。
分析了456例食管癌切除病例。Caprini评分中位数为13分。适当的预防措施使住院期间VTE发生率降低了6.9倍。所有出院后30天和90天的VTE均发生在未接受Caprini指南推荐的VTE预防措施的患者中。住院期间、出院后30天和90天的出血率分别为7.68%、0.91%和2.11%；然而，接受适当预防措施并未增加出血风险。
在这个食管癌切除队列中，Caprini指南推荐的VTE预防措施降低了住院期间VTE事件的发生率，且未增加出血并发症。对于已知术后VTE风险较高的该患者群体，应考虑基于风险的VTE预防措施。
