使用调整后的Caprini评分预测接受结直肠癌手术并采用加速康复外科（ERAS）的老年患者的静脉血栓栓塞，并确定适当的预防措施。
Predicting venous thromboembolism and determining appropriate prophylaxis in elderly patients undergoing colorectal cancer surgery with Enhanced Recovery After Surgery (ERAS) using the adjusted Caprini score.
作者信息
Choi Young Sun, Cho Hyung Jin, Lee Chul Seung, Lee Dong Geun, Chung Choon Sik, Lee Gwan Cheol, Kang Dong Woo, Kim Jeong Sub, Kim Tae Gyu
机构信息
Department of Colorectal Surgery, Hansol Hospital, Seoul, Korea.
Division of Vascular and Transplant Surgery, Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
出版信息
Ann Coloproctol. 2025 Aug;41(4):279-286. doi: 10.3393/ac.2024.00857.0122. Epub 2025 Aug 26.
PURPOSE
Age and postoperative complications are known risk factors for venous thromboembolism (VTE). Minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocol has been implemented to reduce these risks. The purpose of this study was to assess the short- and long-term effects of a VTE prophylaxis program using the Caprini score in elderly patients undergoing minimally invasive colorectal cancer surgery with the ERAS protocol.
METHODS
This retrospective cross-sectional study included 1,043 colorectal cancer patients requiring surgery from January 2017 to December 2019, divided into a control group (≤75 years) and an elderly group (>75 years), with 827 and 216 patients, respectively. The primary outcome was the incidence of VTE; secondary outcome was the incidence of postoperative complications, particularly bleeding.
RESULTS
The incidence of VTE was 1.5% in the control group and 3.7% in the elderly group (P=0.061). Five patients (0.5%) experienced symptomatic VTE, and the Caprini score for all VTE patients was ≤8 points; thus, only mechanical prophylaxis was used. In the multivariable logistic regression, the Caprini score (P=0.024) and cancer stage (P=0.004) were selected. The odds ratios (95% confidence interval) of the Caprini score and TNM staging were 1.758 (1.078-2.867) and 6.152 (2.045-26.510), respectively.
CONCLUSIONS
When the ERAS protocol was used for patients with colorectal cancer as perioperative care, the VTE risk was lower than that estimated by the Caprini score. Given that age is a recognized risk factor for major bleeding, criteria for the use of anticoagulation to prevent VTE, particularly in elderly patients, should be carefully evaluated, considering both the bleeding risks and the potential benefits of pharmacologic prophylaxis.
TRIAL REGISTRATION
Clinical Research Information Service (CRIS; cris.nih.go.kr) identifier: KCT0007804.
目的
年龄和术后并发症是已知的静脉血栓栓塞症（VTE）风险因素。已实施微创手术和术后加速康复（ERAS）方案以降低这些风险。本研究的目的是评估在接受ERAS方案的微创结直肠癌手术的老年患者中，使用Caprini评分的VTE预防方案的短期和长期效果。
方法
这项回顾性横断面研究纳入了2017年1月至2019年12月期间需要手术的1043例结直肠癌患者，分为对照组（≤75岁）和老年组（>75岁），分别有827例和216例患者。主要结局是VTE的发生率；次要结局是术后并发症的发生率，尤其是出血。
结果
对照组VTE发生率为1.5%，老年组为3.7%（P=0.061）。5例患者（0.5%）发生有症状的VTE，所有VTE患者的Caprini评分均≤8分；因此，仅采用了机械预防措施。在多变量逻辑回归中，选择了Caprini评分（P=0.024）和癌症分期（P=0.004）。Caprini评分和TNM分期的比值比（95%置信区间）分别为1.758（1.078-2.867）和6.152（2.045-26.510）。
结论
当将ERAS方案用于结直肠癌患者的围手术期护理时，VTE风险低于Caprini评分所估计的风险。鉴于年龄是公认的大出血风险因素，在考虑出血风险和药物预防的潜在益处的同时，应仔细评估使用抗凝剂预防VTE的标准，尤其是在老年患者中。
试验注册
临床研究信息服务（CRIS；cris.nih.go.kr）标识符：KCT0007804。
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