Academic Urology Unit, Division of Imaging Sciences and Technology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
Department of Pharmacology, AIIMS, Vijaypur, Jammu, India.
World J Surg Oncol. 2024 Feb 23;22(1):67. doi: 10.1186/s12957-023-03170-y.
Venous thromboembolism (VTE) is a potentially life-threatening but preventable complication after urological surgery. Physicians are faced with the challenges of weighing the risks and benefits of thromboprophylaxis given scanty evidence for or against and practice variation worldwide.
The primary objective of the study was to explore the possibility of a risk-stratified approach for thromboembolism prophylaxis following radical prostatectomy.
DESIGN, SETTING, AND PARTICIPANTS: A prospective database was accessed to cross-link venous thromboembolism events in 522 men who underwent minimally invasive prostatectomy between February 2010 and October 2021. A deterministic data linkage method was used to record events through electronic systems. Community Health Index (CHI) numbers were used to identify patients via electronic health records. Patient demographics and clinical characteristics such as age, comorbidities, Gleason staging, and readmission details accrued.
VTE within 90 days and development of a risk-stratified scoring system. All statistical analysis was performed using R-Statistical Software and the risk of VTE within 90 days of surgery was estimated via gradient-boosting decision trees (BRT) model.
1.1% (6/522) of patients developed deep vein thrombosis or pulmonary embolism within 3 months post-minimally invasive prostatectomy. Statistical analysis demonstrated a significant difference in the body mass index (p = 0.016), duration of hospital stay (p < 0.001), and number of readmissions (p = 0.036) between patients who developed VTE versus patients who did not develop VTE. BRT analysis found 8 variables that demonstrated relative importance in predicting VTE. The receiver operating curves (ROC) were constructed to assess the discrimination power of a new model. The model showed an AUC of 0.97 (95% confidence intervals [CI]: 0.945,0.999). For predicting VTE, a single-center study is a limitation.
The incidence of VTE post-minimally invasive prostatectomy in men who did not receive prophylaxis with low molecular weight heparin is low (1.1%). The proposed risk-scoring system may aid in the identification of higher-risk patients for thromboprophylaxis. In this report, we looked at the outcomes of venous thromboembolism following minimally invasive radical prostatectomy for prostate cancer in consecutive men. We developed a new scoring system using advanced statistical analysis. We conclude that the VTE risk is very low and our model, if applied, can risk stratify men for the development of VTE following radical surgery for prostate cancer.
静脉血栓栓塞症（VTE）是泌尿科手术后一种潜在的危及生命但可预防的并发症。医生在权衡血栓预防的风险和益处时面临着挑战，因为全球范围内的证据不足且实践存在差异。
本研究的主要目的是探索一种针对微创前列腺切除术患者血栓栓塞预防的风险分层方法。
设计、地点和参与者：本研究通过回顾性分析，查阅了 2010 年 2 月至 2021 年 10 月期间 522 例接受微创前列腺切除术的男性患者的静脉血栓栓塞事件的前瞻性数据库。使用确定性数据链接方法通过电子系统记录事件。通过电子健康记录使用社区健康指数（CHI）编号来识别患者。收集了患者的人口统计学和临床特征，如年龄、合并症、Gleason 分期和再入院情况。
1.1%（6/522）的患者在微创前列腺切除术后 90 天内发生深静脉血栓形成或肺栓塞。使用 R 统计软件进行所有统计分析，并通过梯度提升决策树（BRT）模型估计手术 90 天内发生 VTE 的风险。研究结果表明，在发生 VTE 的患者与未发生 VTE 的患者之间，体重指数（p=0.016）、住院时间（p<0.001）和再入院次数（p=0.036）存在显著差异。BRT 分析发现了 8 个对预测 VTE 具有相对重要性的变量。构建了接收者操作特征曲线（ROC）来评估新模型的判别能力。该模型的 AUC 为 0.97（95%置信区间[CI]：0.945，0.999）。本研究为单中心研究，存在一定局限性。
在未接受低分子肝素预防性抗凝治疗的微创前列腺切除术后男性中，VTE 的发生率较低（1.1%）。所提出的风险评分系统可能有助于确定更高风险的患者进行血栓预防。在本报告中，我们观察了连续男性接受微创根治性前列腺切除术治疗前列腺癌后静脉血栓栓塞的结局。我们使用先进的统计分析方法开发了一种新的评分系统。我们的结论是 VTE 的风险非常低，如果应用我们的模型，可以对接受根治性前列腺癌手术的男性进行 VTE 风险分层。
