Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice
Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice
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DOI：
10.1503/cjs.012314
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发表时间：
2015-10-01
影响因子：
2.5
通讯作者：
McKay, Andrew
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文献类型：
--
作者：
Alsubaie, Hamad;Leggett, Carly;McKay, Andrew
背景 癌症手术出院后延长血栓预防已被证明可以降低静脉血栓栓塞 (VTE) 的发生率；然而，这种做法并未得到普遍采用。我们进行了一项基于人群的分析，以确定在接受重大腹盆腔癌症手术后首次出院后 90 天内诊断出有症状 VTE 的患者的比例，这些患者可能受益于延长血栓预防。方法我们使用马尼托巴癌症登记处来确定 2004 年至 2009 年间接受过重大腹盆腔癌症手术的患者。在初次住院期间诊断出 VTE 的比例是通过访问医院分离摘要来确定的。出院后诊断出 VTE 的比例是通过检查 90 天内的重复入院情况以及访问药物计划信息网络记录中新开的抗凝剂来确定的。详细的肿瘤和治疗特异性数据允许计算 VTE 预测因子。结果 在确定的 6612 名患者中，106 名 (1.60%) 在初次住院期间诊断出 VTE，96 名 (1.45%) 在出院后出现 VTE。出院后出现 VTE 的患者中，33.3% 患有肺栓塞，24% 患有深静脉血栓，6.3% 两者兼有。出院后 90 天内出现 VTE 的预测因素包括晚期疾病、存在其他并发症、医院资源利用率增加、非结直肠胃肠道起源的原发肿瘤以及年龄小于 45 岁。 VTE 的发生是 5 年总生存率下降的独立预测因素。结论 腹腔盆腔肿瘤大手术后 90 天内 VTE 的累积发生率为 3.01%，其中约一半 (1.45%) 是在出院后 90 天内诊断出来的。
Background Extended thromboprophylaxis after hospital discharge following cancer surgery has been shown to reduce the incidence of venous thromboembolism (VTE); however, this practice has not been universally adopted. We conducted a population-based analysis to determine the proportion of patients with symptomatic VTE diagnosed within 90 days after initial discharge following major abdominopelvic cancer surgery who might have benefited from extended thromboprophylaxis.Methods We used the Manitoba Cancer Registry to identify patients who underwent major abdominopelvic cancer surgery between 2004 and 2009. The proportion in whom VTE was diagnosed during the initial hospital stay was determined by accessing the Hospital Separations Abstracts. The proportion in whom VTE was diagnosed after discharge was determined by examining repeat admissions within 90 days and by accessing Drug Programs Information Network records for newly prescribed anticoagulants. Detailed tumour and treatment-specific data allowed calculation of VTE predictors.Results Of 6612 patients identified, 106 (1.60%) had VTE diagnosed during the initial stay and 96 (1.45%) presented with VTE after discharge. Among patients in whom VTE developed after discharge, 33.3% had a pulmonary embolus, 24% had deep vein thrombosis, and 6.3% had both. Predictors of presenting with VTE after discharge within 90 days of surgery included advanced disease, presence of other complications, increased hospital resource utilization, primary tumours of noncolorectal gastrointestinal origin and age younger than 45 years. The development of VTE was an independent predictor of decreased 5-year overall survival.Conclusion The cumulative incidence of VTE within 90 days of major abdominopelvic oncologic surgery was 3.01%, with about half (1.45%) having been diagnosed within 90 days after discharge.