Aru Roberto G, Tyagi Sam C, Ebbitt Laura M, Patel Jitesh A
University of Kentucky, Lexington, KY, USA.
Surg Pract Sci. 2022 Apr 29;9:100085. doi: 10.1016/j.sipas.2022.100085. eCollection 2022 Jun.
Colorectal surgery (CRS) patients are at high risk for venous thromboembolism (VTE). The Caprini model elucidates that comorbidities compound to increase VTE risk, but this association in CRS patients remains undefined. We hypothesize that the compounding presence of comorbidities in patients undergoing colorectal resection (CRR) or small bowel resection (SBR) is associated with greater postoperative VTE risk.
This study was a single-institution, retrospective review of patients undergoing CRR and/or SBR from July 2011 to July 2020. Patient demographics, baseline laboratory values, medical comorbidities, and 30-day outcomes were recorded. Incidence of 30-day preoperative or postoperative VTE, including deep venous thrombosis (DVT), pulmonary embolism (PE), portal vein thrombosis (PVT), or inferior vena cava thrombosis (IVCT), were determined. All patients received multimodal in-hospital VTE prophylaxis. After July 2017, patients at high risk for VTE received post-discharge extended chemoprophylaxis.
A total of 4354 patients were identified; 129 patients had a postoperative VTE. There was a high incidence of pre-existing comorbidities. In multivariate analysis, acute kidney injury ( = 0.002) and preoperative 30-day VTE (<0.001), American Society of Anesthesiologists classification IV ( = 0.015) and V ( = 0.041), and inherited hypercoagulability states ( = 0.029) were associated with postoperative VTEs. In a logistic regression model, multiple comorbidities (<0.001) and preoperative VTE (<0.001) were predictive of postoperative VTE. Open SBR ( = 0.004) and open ( = 0.001) and laparoscopic (<0.001) colectomy were associated with postoperative VTE. After July 2017, there were lower rates of postoperative VTE ( = 0.041).
Multimorbidity is linearly associated with increased rates of postoperative VTE after CRS surgery. This high-risk population could benefit from novel in-hospital and post-hospital VTE prophylaxis measures.
结直肠手术（CRS）患者发生静脉血栓栓塞症（VTE）的风险很高。卡普里尼模型表明，合并症会增加VTE风险，但CRS患者中的这种关联尚不清楚。我们假设，接受结直肠切除术（CRR）或小肠切除术（SBR）的患者合并症的存在会增加术后VTE风险。
本研究是对2011年7月至2020年7月期间接受CRR和/或SBR的患者进行的单机构回顾性研究。记录患者的人口统计学信息、基线实验室值、合并症和30天结局。确定30天术前或术后VTE的发生率，包括深静脉血栓形成（DVT）、肺栓塞（PE）、门静脉血栓形成（PVT）或下腔静脉血栓形成（IVCT）。所有患者均接受多模式院内VTE预防。2017年7月后，VTE高危患者接受出院后延长化学预防。
共确定4354例患者；129例患者术后发生VTE。既往合并症的发生率很高。在多变量分析中，急性肾损伤（P = 0.002）、术前30天VTE（P<0.001）、美国麻醉医师协会分级IV（P = 0.015）和V（P = 0.041）以及遗传性高凝状态（P = 0.029）与术后VTE相关。在逻辑回归模型中，多种合并症（P<0.001）和术前VTE（P<0.001）可预测术后VTE。开放性SBR（P = 0.004）、开放性（P = 0.001）和腹腔镜（P<0.001）结肠切除术与术后VTE相关。2017年7月后，术后VTE发生率较低（P = 0.041）。
合并症与CRS手术后术后VTE发生率增加呈线性相关。这一高危人群可从新型院内和院后VTE预防措施中获益。
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