Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy.
Development and validation of a risk calculator for post-discharge venous thromboembolism following hepatectomy for malignancy.
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DOI：
10.1016/j.hpb.2020.09.008
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Bentrem DJ
中科院分区：
文献类型：
--
作者：
Schlick CJR;Ellis RJ;Merkow RP;Yang AD;Bentrem DJ
出院后静脉血栓栓塞（VTE）化学预防可以减少癌症手术后的静脉血栓栓塞，但识别高危患者仍然很困难。我们的目标是：(1)确定出院时与恶性肝切除术后静脉血栓栓塞相关的因素；(2)开发并验证出院后静脉血栓栓塞风险计算器，以评估患者特异性风险。从ACS NSQIP肝切除术手术靶向模块中确定2014年至2017年因恶性肿瘤接受肝切除术的患者。多变量logistic回归确定了与出院后静脉血栓栓塞相关的因素。构建出院后静脉血栓栓塞风险计算器，计算出院后静脉血栓栓塞的预测概率。在11 172例患者中，95例（0.9%）发生出院后静脉血栓栓塞。出院后静脉血栓栓塞与肥胖BMI （OR 2.29 vs.正常BMI [95%CI 1.31-3.99]）、右肝切除术/三节切除术（OR 1.63 vs.部分/楔形[95%CI 1.04-2.57]）和一些住院术后并发症相关：肾功能不全（OR 5.29 [95%CI 1.99-14.07]）、输血（OR 1.77 [95%CI 1.12-2.80]）、非手术性手术干预（OR 2.97 [95%CI 1.81-4.86]）和肝切除术后肝功能衰竭（OR 2.22 [95%CI 1.21-4.08]）。出院后静脉血栓栓塞的风险从0.3%到30.2%不等。20次10倍交叉验证确定内部效度。来自所有护理阶段的危险因素，包括住院并发症，与肝切除术后出院后静脉血栓栓塞有关。识别高危患者可能允许个性化的基于风险的出院后化学预防处方。
Post-discharge venous thromboembolism (VTE) chemoprophylaxis decreases VTEs following cancer surgery, however identifying high-risk patients remains difficult. Our objectives were to (1) identify factors available at hospital discharge associated with post-discharge VTE following hepatectomy for malignancy and (2) develop and validate a post-discharge VTE risk calculator to evaluate patient-specific risk. Patients who underwent hepatectomy for malignancy from 2014 to 2017 were identified from the ACS NSQIP hepatectomy procedure targeted module. Multivariable logistic regression identified factors associated with post-discharge VTE. A post-discharge VTE risk calculator was constructed, and predicted probabilities of post-discharge VTE were calculated. Among 11 172 patients, 95 (0.9%) developed post-discharge VTE. Post-discharge VTE was associated with obese BMI (OR 2.29 vs. normal BMI [95%CI 1.31–3.99]), right hepatectomy/trisegmentectomy (OR 1.63 vs. partial/wedge [95%CI 1.04–2.57]), and several inpatient postoperative complications: renal insufficiency (OR 5.29 [95%CI 1.99–14.07]), transfusion (OR 1.77 [95%CI 1.12–2.80]), non-operative procedural intervention (OR 2.97 [95%CI 1.81–4.86]), and post-hepatectomy liver failure (OR 2.22 [95%CI 1.21–4.08]). Post-discharge VTE risk ranged from 0.3% to 30.2%. Twenty iterations of 10-fold cross validation identified internal validity. Risk factors from all phases of care, including inpatient complications, are associated with post-discharge VTE following hepatectomy. Identifying high-risk patients may allow for personalized risk-based post-discharge chemoprophylaxis prescribing.
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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：
2.5
作者：
Alsubaie, Hamad;Leggett, Carly;McKay, Andrew
通讯作者：
McKay, Andrew
影响因子：
2.9
作者：
Anh-Thu Le;Harris, Jennifer W.;Tzeng, Ching-Wei D.
通讯作者：
Tzeng, Ching-Wei D.
影响因子：
9.6
作者：
Gould, Michael K.;Garcia, David A.;Samama, Charles M.
通讯作者：
Samama, Charles M.