A postdischarge venous thromboembolism risk calculator for inflammatory bowel disease surgery.
A postdischarge venous thromboembolism risk calculator for inflammatory bowel disease surgery.
复制标题
炎性肠病手术的静脉后血栓栓塞风险计算器。
DOI：
10.1016/j.surg.2020.09.006
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发表时间：
2021-03
期刊：
影响因子：
3.8
通讯作者：
Merkow RP
中科院分区：
文献类型：
--
作者：
Schlick CJR;Yuce TK;Yang AD;McGee MF;Bentrem DJ;Bilimoria KY;Merkow RP
指南推荐对因炎症性肠病手术的高危患者静脉血栓栓塞进行延长的化学预防。然而，量化患者静脉血栓栓塞的风险仍然具有挑战性。我们寻求(1)确定因炎症性肠病而接受结肠直肠切除术的患者出院后静脉血栓栓塞的相关因素；(2)开发出院后静脉血栓栓塞风险计算器，以指导延长化疗预防的处方。从2012年至2018年接受炎症性肠病手术的患者从美国外科医师学会国家手术质量改进计划中确定了结肠切除术和直肠切除术的靶向模块。出院后静脉血栓栓塞包括出院后诊断的肺栓塞或深静脉血栓。多变量logistic回归估计患者/手术因素与出院后静脉血栓栓塞的关联。随后构建了出院后静脉血栓栓塞风险计算器。在18,990例患者中，199例（1.1%）在术后前30天内发生出院后静脉血栓栓塞。术前与出院后静脉血栓栓塞相关的因素包括体重指数（体重指数≥35者1.9% vs体重指数18.5-24.9者0.8%；比值比2.34[95%可信区间1.49-3.67]）、类固醇使用（1.3% vs 0.7%；比值比1.91[95%可信区间1.37-2.66]）和溃疡性结肠炎（克罗恩病者1.5% vs 0.8%；比值比1.76[95%可信区间1.32-2.34]）。微创手术与出院后静脉血栓栓塞（1.2% vs 0.9%；优势比1.42[95%可信区间1.05-1.92]）、吻合口漏（2.8% vs 1.0%；优势比2.24[95%可信区间1.31-3.83]）和肠梗阻（2.1% vs 0.9%；优势比2.60[95%可信区间1.91-3.54]）相关。根据个体危险因素，预测出院后静脉血栓栓塞的概率从0.2%到14.3%不等。术前、术中和术后因素与炎性肠病手术后静脉血栓栓塞相关。开发了一种出院后静脉血栓栓塞风险计算器，可根据个体风险定制扩展静脉血栓栓塞化学预防。
Guidelines recommend extended chemoprophylaxis for venous thromboembolism in high-risk patients having operations for inflammatory bowel disease. Quantifying patients’ risk of venous thromboembolism, however, remains challenging. We sought (1) to identify factors associated with postdischarge venous thromboembolism in patients undergoing colorectal resection for inflammatory bowel disease and (2) to develop a postdischarge venous thromboembolism risk calculator to guide prescribing of extended chemoprophylaxis. Patients who underwent an operation for inflammatory bowel disease from 2012 to 2018 were identified from the American College of Surgeons National Surgical Quality Improvement Program for colectomy and proctectomy procedure targeted modules. Postdischarge venous thromboembolism included pulmonary embolism or deep vein thrombosis diagnosed after discharge from the index hospitalization. Multivariable logistic regression estimated the association of patient/operative factors with postdischarge venous thromboembolism. A postdischarge venous thromboembolism risk calculator was subsequently constructed. Of 18,990 patients, 199 (1.1%) developed a postdischarge venous thromboembolism within the first 30 postoperative days. Preoperative factors associated with postdischarge venous thromboembolism included body mass index (1.9% with body mass index ≥35 vs 0.8% with body mass index 18.5–24.9; odds ratio 2.34 [95% confidence interval 1.49–3.67]), steroid use (1.3% vs 0.7%; odds ratio 1.91 [95% confidence interval 1.37–2.66]), and ulcerative colitis (1.5% vs 0.8% with Crohn’s disease; odds ratio 1.76 [95% confidence interval 1.32–2.34]). Minimally invasive surgery was associated with postdischarge venous thromboembolism (1.2% vs 0.9% with open; odds ratio 1.42 [95% confidence interval 1.05–1.92]), as was anastomotic leak (2.8% vs 1.0%; odds ratio 2.24 [95% confidence interval 1.31–3.83]) and ileus (2.1% vs 0.9%; odds ratio 2.60 [95% confidence interval 1.91–3.54]). The predicted probability of postdischarge venous thromboembolism ranged from 0.2% to 14.3% based on individual risk factors. Preoperative, intraoperative, and postoperative factors are associated with postdischarge venous thromboembolism after an operation for inflammatory bowel disease. A postdischarge venous thromboembolism risk calculator was developed which can be used to tailor extended venous thromboembolism chemoprophylaxis by individual risk.
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