Extended Venous Thromboembolism Prophylaxis After Elective Surgery for IBD Patients: Nomogram-Based Risk Assessment and Prediction from Nationwide Cohort
Extended Venous Thromboembolism Prophylaxis After Elective Surgery for IBD Patients: Nomogram-Based Risk Assessment and Prediction from Nationwide Cohort
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DOI：
10.1097/dcr.0000000000001189
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发表时间：
2018-10-01
影响因子：
3.9
通讯作者：
Steele, Scott R.
中科院分区：
文献类型：
--
作者：
Benlice, Cigdem;Holubar, Stefan D.;Steele, Scott R.
背景技术背景：识别术后静脉血栓栓塞的危险因素是降低IBD患者择期手术后与这种潜在可预防并发症相关的发病率的重要一步。目的：本研究旨在确定静脉血栓栓塞患者腹部手术后30天静脉血栓栓塞的风险因素，确定延长血栓预防的潜在适应症，设计：回顾性队列研究，前瞻性收集数据库，地点：美国外科医师学会国家外科质量改进计划参与者用户文件，2005 - 2016年。所有接受择期腹盆腔肠道手术的IBD患者均纳入研究。主要观察指标：主要结果是在指数腹盆腔手术后30天内住院和出院后静脉血栓栓塞的发生率。共有24，182例患者符合入选标准。30天总静脉血栓栓塞率和出院后静脉血栓栓塞率分别为2.5%（n = 614）和1%（n =252）。41%（252/614）的静脉血栓栓塞事件发生在出院后。单变量分析评估了37个变量与研究结果的相关性。多因素Logistic回归分析显示，年龄较大、类固醇使用、出血性疾病、开放手术、高血压、手术时间较长和术前住院与出院前静脉血栓栓塞相关，术后输血、类固醇使用、盆腔和肠外瘘手术和手术时间较长与出院后静脉血栓栓塞相关。为每个结果构建列线图，将多变量模型参数估计值转换为视觉评分系统，在该系统中可以计算静脉血栓栓塞的估计概率。鉴于IBD患者在择期腹盆手术后发生静脉血栓栓塞的风险高于其他适应症，使用所提出的列线图在出院之前和之后对静脉血栓栓塞的准确预测可以促进在术前设置中作为筛选工具的个体化扩展血栓预防的决策。请参阅http://links.lww.com/DCR/A711上的视频摘要。
BACKGROUND: Identification of risk factors for postoperative venous thromboembolism is an important step to reduce the morbidity associated with this potentially preventable complication after elective surgery for patients with IBD.OBJECTIVE: This study aimed to determine the risk factors for 30-day venous thromboembolism after abdominal surgery for patients with venous thromboembolism, identify potential indications for extended thromboprophylaxis, and develop a nomogram for prediction of risk.DESIGN: This is a retrospective cohort study from a prospectively collected database.SETTING: The American College of Surgeons National Surgical Quality Improvement Program Participant User File from 2005 to 2016 was used for data analysis.PATIENTS: All patients with IBD undergoing elective abdominopelvic bowel surgery were included.MAIN OUTCOME MEASURES: The primary outcomes were the incidence of in-hospital and postdischarge venous thromboembolism within 30 days of the index abdominopelvic surgery.RESULTS: A total of 24,182 patients met the inclusion criteria. Thirty-day total and postdischarge rates of venous thromboembolism were 2.5% (n = 614) and 1% (n =252). Forty-one percent (252/614) of venous thromboembolism events occurred after hospital discharge. Univariate analysis assessed 37 variables for association with study outcomes. On multivariate logistic regression analysis, older age, steroid use, bleeding disorders, open surgery, hypertension, longer operative time, and preoperative hospitalization were associated with venous thromboembolism before discharge and also postoperative transfusion, steroid use, pelvic and enterocutaneous fistula surgery, and longer operative time were associated with venous thromboembolism after discharge. A nomogram was constructed for each outcome, translating multivariate model parameter estimates into a visual scoring system where the estimated probability of venous thromboembolism can be calculated.LIMITATIONS: This study was limited by its retrospective nature and the limitations inherent to a database.CONCLUSION: Given the higher risk of venous thromboembolism in patients with IBD after elective abdominopelvic surgery compared with other indications, an accurate prediction of venous thromboembolism before and after discharge using the proposed nomogram can facilitate decision making for individualized extended thromboprophylaxis in the preoperative setting as a screening tool. See Video Abstract at http://links.lww.com/DCR/A711.