Post-discharge venous thromboembolism after pancreatectomy for malignancy: Predicting risk based on preoperative, intraoperative, and postoperative factors.
Post-discharge venous thromboembolism after pancreatectomy for malignancy: Predicting risk based on preoperative, intraoperative, and postoperative factors.
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DOI：
10.1002/jso.26046
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发表时间：
2020-09
影响因子：
2.5
通讯作者：
Bentrem DJ
中科院分区：
文献类型：
--
作者：
Schlick CJR;Merkow RP;Yang AD;Bentrem DJ
建议对恶性肿瘤胰腺切除术后的高危患者进行延长化学预防。然而，量化风险仍然很困难。我们试图 (1) 确定与恶性肿瘤胰腺切除术后出院后 VTE 相关的因素，以及 (2) 开发出院后 VTE 风险计算器来识别高危患者。从 ACS NSQIP 胰腺切除手术目标数据集中确定了 2014 年至 2018 年因恶性组织学原因接受胰腺切除术的患者。通过多变量逻辑回归评估出院时已知的术前、术中和术后因素与出院后 VTE 的关联。开发并验证了出院后 VTE 风险计算器。在 19,340 名分析患者中，280 名 (1.5%) 出现出院后 VTE。出院后 VTE 与 BMI 增加相关（例如，病态肥胖 BMI OR 1.99 [95% CI 1.30-3.02] 与正常 BMI 相比）、手术类型（远端胰腺切除术 OR 1.47 [95% CI 1.02-2.12] 与胰十二指肠切除术相比）、胰瘘（OR 1.59 [95% CI 1.02-2.12] 与胰十二指肠切除术）相关1.19–2.13]）和胃排空延迟（OR 1.81 [95% CI 1.29–2.52]）。患者出院后 VTE 的预测概率范围为 0.7%−9.0%。 10 倍交叉验证的 20 次迭代证明了内部有效性。术前、术中和术后因素与恶性肿瘤胰腺切除术后出院后 VTE 相关。该出院后 VTE 风险计算器可以量化个人出院后 VTE 风险，范围为 0.7% 至 9.0%。
Extended chemoprophylaxis is recommended for high-risk patients following pancreatectomy for malignancy. However, quantifying risk remains difficult. We sought to (1) identify factors associated with post-discharge VTE following pancreatectomy for malignancy and (2) develop a post-discharge VTE risk calculator to identify high-risk patients. Patients who underwent pancreatectomy for malignant histology from 2014–2018 were identified from the ACS NSQIP pancreatectomy procedure targeted dataset. Preoperative, intraoperative, and postoperative factors known at hospital discharge were evaluated for association with post-discharge VTE via multivariable logistic regression. A post-discharge VTE risk calculator was developed and validated. Of 19,340 analyzed patients, 280 (1.5%) developed post-discharge VTE. Post-discharge VTE was associated with increasing BMI (e.g., morbidly obese BMI OR 1.99 [95% CI 1.30–3.02] vs. normal BMI), procedure type (distal pancreatectomy OR 1.47 [95% CI 1.02–2.12] vs. pancreaticoduodenectomy), pancreatic fistula (OR 1.59 [95% CI 1.19–2.13]) and delayed gastric emptying (OR 1.81 [95% CI 1.29–2.52]). Patients’ predicted probability of post-discharge VTE ranged from 0.7%−9.0%. Twenty iterations of 10-fold cross-validation demonstrated internal validity. Preoperative, intraoperative, and postoperative factors were associated with post-discharge VTE following pancreatectomy for malignancy. This post-discharge VTE risk calculator allows for quantifying individual post-discharge VTE risk, which ranged from 0.7% to 9.0%.
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影响因子：
45.3
作者：
Key, Nigel S.;Khorana, Alok A.;Falanga, Anna
通讯作者：
Falanga, Anna
DOI：
10.1007/s11605-013-2373-4
发表时间：
2014-01
期刊：
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
影响因子：
--
作者：
Iannuzzi JC;Rickles AS;Kelly KN;Fleming FJ;Dolan JG;Monson JR;Noyes K
通讯作者：
Noyes K
影响因子：
0.4
作者：
Javed, Ammar A.;Aziz, Kanza;Wolfgang, Christopher L.
通讯作者：
Wolfgang, Christopher L.
影响因子：
4
作者：
Caprini, JA
通讯作者：
Caprini, JA
影响因子：
9.6
作者：
Gould, Michael K.;Garcia, David A.;Samama, Charles M.
通讯作者：
Samama, Charles M.