Hui Michael W Q, Pinheiro Adlin A, Chen Xianyan, Lin Zhizhong, Meister Amanda, Suzuki Kei, Litle Virginia R
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Boston University School of Public Health, Boston, Massachusetts.
Ann Thorac Surg Short Rep. 2022 Oct 29;1(1):194-198. doi: 10.1016/j.atssr.2022.10.014. eCollection 2023 Mar.
The risk of venous thromboembolism (VTE) in patients undergoing resection in the setting of lung cancer represents a major challenge to improving postoperative outcomes. The Caprini risk assessment model has been validated in general surgery to determine a role for extended chemoprophylaxis to reduce VTE events. Our goal was to simplify this burdensome model for the unique needs of this thoracic surgical population to better guide anticoagulation decision-making.
Patients who underwent a resection for lung malignant neoplasm at our institution between June 2005 and June 2013 with available 60-day postoperative follow-up data were evaluated. Exclusion criteria were long-term anticoagulation, inferior vena cava filter, missing data, and loss to follow-up. Twelve selected risk factors were analyzed for each patient by logistic regression with stepwise inclusion to model 60-day VTE incidence.
There were 225 patients eligible for inclusion, and a VTE incidence of 5.8% was observed. We generated a 5-variable model with predictive ability for VTE occurrence similar to that of the Caprini risk assessment model ( = .29). Weighting of sex, age, history of VTE, surgical approach, and duration of procedure provides a low-risk or high-risk composite score with 56% sensitivity and 77% specificity.
In this effort to model VTE incidence on the basis of a limited set of clinical risk factors, we demonstrated efficacy of retrospectively scoring patients with just 5 data points in anticipating risk of postoperative VTE. These high-risk surgical patients can be readily identified in the preoperative period to benefit from extended postoperative prophylaxis.
肺癌患者手术切除后发生静脉血栓栓塞症（VTE）的风险是改善术后结局的一项重大挑战。Caprini风险评估模型已在普通外科手术中得到验证，以确定延长化学预防在减少VTE事件方面的作用。我们的目标是针对胸外科患者的独特需求简化这个繁琐的模型，以更好地指导抗凝决策。
对2005年6月至2013年6月在我院接受肺恶性肿瘤切除术且有术后60天随访数据的患者进行评估。排除标准为长期抗凝、下腔静脉滤器、数据缺失和失访。通过逐步纳入的逻辑回归分析每位患者的12个选定风险因素，以建立60天VTE发生率模型。
有225例患者符合纳入标准，观察到VTE发生率为5.8%。我们生成了一个5变量模型，其对VTE发生的预测能力与Caprini风险评估模型相似（=0.29）。对性别、年龄、VTE病史、手术方式和手术持续时间进行加权，可得出低风险或高风险综合评分，灵敏度为56%，特异度为77%。
在基于有限的临床风险因素对VTE发生率进行建模的这项研究中，我们证明了仅用5个数据点对患者进行回顾性评分在预测术后VTE风险方面的有效性。这些高风险手术患者在术前即可轻松识别，以便从延长的术后预防中获益。
