Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: a prospective, multicenter cohort study

被引：27

作者：

Wei, Qi ^{[1
]}

Wei, Zheng-Qiang ^{[2
]}

Jing, Chang-Qing ^{[3
]}

Li, Yong-Xiang ^{[4
]}

Zhou, Dong-Bing ^{[5
]}

Lin, Mou-Bin ^{[6
]}

He, Xian-Li ^{[7
]}

Li, Fan ^{[8
]}

Liu, Qian ^{[9
]}

Zheng, Jian-Yong ^{[10
]}

Wang, Gui-Ying ^{[11
]}

Tu, Shi-Liang ^{[12
]}

Wang, Zhen-Jun ^{[13
]}

Li, Ang ^{[14
]}

Xiao, Gang ^{[15
]}

Zhuang, Jing ^{[16
]}

Bai, Lian ^{[17
]}

Huang, He ^{[18
]}

Li, Yong ^{[19
]}

Song, Wu ^{[20
]}

Liang, Zhong-Lin ^{[21
]}

Shen, Zhan-Long ^{[22
]}

Liu, Fan-Long ^{[23
]}

Dai, Yong ^{[24
]}

Zhou, Xiao-Jun ^{[25
]}

Dong, Ming ^{[26
]}

Wang, Hui ^{[27
]}

Qiu, Jian ^{[28
]}

Zhou, Lei ^{[29
]}

Li, Xin-Xiang ^{[30
]}

Wang, Zi-Qiang ^{[31
]}

Zhang, Hong ^{[32
]}

Wang, Quan ^{[33
]}

Pang, Ming-Hui ^{[34
,35
]}

Wei, Hong-Bo ^{[36
]}

Hu, Zhi-Qian ^{[37
]}

Yan, Yi-Dan ^{[38
]}

Che, Yan ^{[39
]}

Gu, Zhi-Chun ^{[38
,41
]}

Yao, Hong-Wei ^{[1
,40
]}

Zhang, Zhong-Tao ^{[1
,40
]}

机构：

[1] Capital Med Univ, Beijing Friendship Hosp, Natl Clin Res Ctr Digest Dis, Dept Gen Surg, Beijing, Peoples R China

[2] Chongqing Med Univ, Affiliated Hosp 1, Dept Gastrointestinal Surg, Chongqing, Peoples R China

[3] Shandong First Med Univ, Shandong Prov Hosp, Dept Gastrointestinal Surg, Jinan, Shandong, Peoples R China

[4] Anhui Med Univ, Affiliated Hosp 1, Dept Gen Surg, Hefei, Anhui, Peoples R China

[5] North Sichuan Med Coll, Affiliated Nanchong Cent Hosp, Dept Gastrointestinal Surg, Nanchong, Sichuan, Peoples R China

[6] Tongji Univ, Yangpu Hosp, Sch Med, Dept Gen Surg, Shanghai, Peoples R China

[7] Air Force Med Univ, Tangdu Hosp, Dept Gen Surg, Xian, Shannxi, Peoples R China

[8] Army Med Univ, Daping Hosp, Dept Gen Surg, Chongqing, Peoples R China

[9] Chinese Acad Med Sci & Peking Union Med Coll, Canc Hosp, Natl Clin Res Ctr Canc, Natl Canc Ctr,Dept Colorectal Surg, Beijing, Peoples R China

[10] AF Mil Med Univ, Affiliated Hosp 1, Dept Gastrointestinal Surg, Xian, Shaanxi, Peoples R China

[11] Hebei Med Univ, Hosp 2, Dept Gen Surg, Shijiazhuang, Hebei, Peoples R China

[12] Hangzhou Med Coll, Zhejiang Prov Peoples Hosp, Affiliated Peoples Hosp, Dept Colorectal Surg,General Surg,Canc Ctr, Hangzhou, Zhejiang, Peoples R China

[13] Capital Med Univ, Beijing Chao Yang Hosp, Dept Gen Surg, Beijing, Peoples R China

[14] Capital Med Univ, Xuanwu Hosp, Dept Gen Surg, Beijing, Peoples R China

[15] Beijing Hosp, Natl Ctr Gerontol, Dept Gastrointestinal Surg, Beijing, Peoples R China

[16] Zhengzhou Univ, Affiliated Canc Hosp, Henan Canc Hosp, Dept Gen Surg, Zhengzhou, Henan, Peoples R China

[17] Chongqing Med Univ, Yongchuan Hosp, Dept Gastrointestinal Surg, Chongqing, Peoples R China

[18] Shanxi Med Univ, Hosp 1, Dept Gastrointestinal Surg, Taiyuan, Shanxi, Peoples R China

[19] Guangdong Prov Peoples Hosp, Dept Gastrointestinal Surg, Dept Gen Surg, Guangzhou, Guangdong, Peoples R China

[20] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Gastrointestinal Surg, Guangzhou, Guangdong, Peoples R China

[21] Shanghai Jiao Tong Univ, Xinhua Hosp, Sch Med, Dept Colorectal & Anal Surg, Shanghai, Peoples R China

[22] Peking Univ, Peoples Hosp, Dept Gastroenterol Surg, Beijing, Peoples R China

[23] Zhejiang Univ, Affiliated Hosp 1, Sch Med, Hangzhou, Zhejiang, Peoples R China

[24] Shandong Univ, Qilu Hosp, Dept Gen Surg, Jinan, Shandong, Peoples R China

[25] Soochow Univ, Affiliated Hosp 1, Dept Gen Surg, Suzhou, Jiangsu, Peoples R China

[26] China Med Univ, First Hosp, Dept Gastrointestinal Surg, Shenyang, Liaoning, Peoples R China

[27] Sun Yat Sen Univ, Affiliated Hosp 6, Dept Colorectal Surg, Guangzhou, Guangdong, Peoples R China

[28] Shaanxi Prov Peoples Hosp, Dept Gen Surg, Xian, Shaanxi, Peoples R China

[29] China Japan Friendship Hosp, Dept Gen Surg, Beijing, Peoples R China

[30] Fudan Univ, Shanghai Canc Ctr, Dept Colorectal Surg, Shanghai, Peoples R China

[31] Sichuan Univ, West China Hosp, Colorectal Canc Ctr, Dept Gen Surg, Chengdu, Sichuan, Peoples R China

[32] China Med Univ, Shengjing Hosp, Dept Colorectal Oncol, Gen Surg Dept 4, Shenyang, Liaoning, Peoples R China

[33] Jilin Univ, Hosp 1, Gen Surg Ctr, Dept Gastr & Colorectal Surg, Changchun, Jilin, Peoples R China

[34] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Dept Geriatr Surg, Chengdu, Sichuan, Peoples R China

[35] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Dept Gastrointestinal Surg, Chengdu, Sichuan, Peoples R China

[36] Sun Yat Sen Univ, Affiliated Hosp 3, Dept Gastrointestinal Surg, Guangzhou, Guangdong, Peoples R China

[37] Tongji Univ, Tongji Hosp, Med Coll, Dept Gastrointestinal Surg, Shanghai, Peoples R China

[38] Shanghai Jiao Tong Univ, Ren Ji Hosp, Sch Med, Dept Pharm, Shanghai, Peoples R China

[39] Shanghai Inst Biomed & Pharmaceut Technol, NHC Key Lab Reprod Regulat, Shanghai, Peoples R China

[40] Capital Med Univ, Beijing Friendship Hosp, Natl Clin Res Ctr Digest Dis, Dept Gen Surg, Beijing 100050, Peoples R China

[41] Shanghai Jiao Tong Univ, Ren Ji Hosp, Sch Med, Dept Pharm, Shanghai 200127, Peoples R China

来源：

INTERNATIONAL JOURNAL OF SURGERY | 2023年 / 109卷 / 10期

关键词：

colorectal cancer; prediction model; prophylaxis; risk factors; venous thromboembolism; DEEP-VEIN THROMBOSIS; HOSPITAL DISCHARGE; ASSESSMENT MODEL; PROPHYLAXIS; THROMBOPROPHYLAXIS; VALIDATION; IDENTIFICATION; COMPRESSION; DISEASE;

D O I：

10.1097/JS9.0000000000000553

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Venous thromboembolism (VTE) is a common and serious complication after colorectal cancer (CRC) surgery. Few large-sample studies have reported VTE incidence and management status after CRC surgery in China. This study aimed to investigate the incidence and prevention of VTE in Chinese patients after CRC surgery, identify risk factors for developing VTE, and construct a new scoring system for clinical decision-making and care planning.Methods: Participants were recruited from 46 centers in 17 provinces in China. Patients were followed up for 1 month postoperatively. The study period was from May 2021 to May 2022. The Caprini score risk stratification and VTE prevention and incidence were recorded. The predictors of the occurrence of VTE after surgery were identified by multivariate logistic regression analysis, and a prediction model (CRC-VTE score) was developed.Results: A total of 1836 patients were analyzed. The postoperative Caprini scores ranged from 1 to 16 points, with a median of 6 points. Of these, 10.1% were classified as low risk (0-2 points), 7.4% as moderate risk (3-4 points), and 82.5% as high risk (>= 5 points). Among these patients, 1210 (65.9%) received pharmacological prophylaxis, and 1061 (57.8%) received mechanical prophylaxis. The incidence of short-term VTE events after CRC surgery was 11.2% (95% CI 9.8-12.7), including deep venous thrombosis (DVT) (11.0%, 95% CI 9.6-12.5) and pulmonary embolism (PE) (0.2%, 95% CI 0-0.5). Multifactorial analysis showed that age (>= 70 years), history of varicose veins in the lower extremities, cardiac insufficiency, female sex, preoperative bowel obstruction, preoperative bloody/tarry stool, and anesthesia time at least 180 min were independent risk factors for postoperative VTE. The CRC-VTE model was developed from these seven factors and had good VTE predictive performance (C-statistic 0.72, 95% CI 0.68-0.76).Conclusions: This study provided a national perspective on the incidence and prevention of VTE after CRC surgery in China. The study offers guidance for VTE prevention in patients after CRC surgery. A practical CRC-VTE risk predictive model was proposed.

引用

页码：3003 / 3012

页数：10

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