Risk Factors For Postoperative Venous Thromboembolism Research Articles

Risk factors for post-operative VTE following colorectal surgery: Is caprini score enough?

BackgroundPost-operative colorectal venous thromboembolism (VTE) rates range between 1 and 3%. Often, surgeons utilize risk assessment models, like the modified Caprini, to determine need for prophylaxis. However, studies reveal additional unaccounted risk factors like preoperative serum albumin level, perioperative blood transfusion, emergency surgery, and preoperative steroid use. MethodsThis was a multicenter, retrospective study conducted between January 2021–December 2021. The primary endpoint was to assess the VTE rate within 30 days post-operatively. ResultsOverall, incidence rate was 1.75%. Of these, 53% underwent urgent/emergent surgery and 60% had perioperative blood transfusions. Twelve patients had a known preoperative serum albumin level, with 66% being less than 3.5 ​g/dL. Only 30% of patients had a high Caprini risk score. No patient had preoperative steroid use. ConclusionThe study suggests considering urgent/emergent surgeries, low preoperative albumin levels, and blood transfusions for enhanced VTE screening and prophylaxis in post-operative colorectal patients.

Construction and Validation of a Nomogram to Predict the Postoperative Venous Thromboembolism Risk in Patients with HGSOC.

Venous thromboembolism (VTE) is a common complication in patients with high-grade serous ovarian cancer (HGSOC) after surgery. This study aims to establish a comprehensive risk assessment model to better identify the potential risk of postoperative VTE in HGSOC. Clinical data from 587 HGSOC patients who underwent surgical treatment were retrospectively collected. Univariate and multivariate logistic regression analyses were performed to identify independent factors influencing the occurrence of postoperative VTE in HGSOC. A nomogram model was constructed in the training set and further validated in the verification set. Logistic regression identified age (odds ratio [OR] = 1.063, P = .002), tumor size (OR = 3.815, P < .001), postoperative transfusion (OR = 5.646, P = .001), and postoperative D-dimer (OR = 1.246, P = .003) as independent risk factors for postoperative VTE in HGSOC patients. A nomogram was constructed using these factors. The receiver operating characteristic curve showed an area under the curve (AUC) of 0.840 (95% confidence interval [CI]: 0.782, 0.898) in the training set and 0.793 (95% CI: 0.704, 0.882) in the validation set. The calibration curve demonstrated a good consistency between model predictions and actual results. The decision curve analysis indicated the model benefits at a threshold probability of less than 70%. A nomogram predicting postoperative VTE in HGSOC was established and validated. This model will assist clinicians in the early identification of high-risk patients, enabling the implementation of appropriate preventive measures.

Nomogram for predicting venous thromboembolism after spinal surgery

PurposeThis study aimed to establish a nomogram to predict the risk of venous thromboembolism (VTE), identifying potential risk factors, and providing theoretical basis for prevention of VTE after spinal surgery.MethodsA retrospective analysis was conducted on 2754 patients who underwent spinal surgery. The general characteristics of the training group were initially screened using univariate logistic analysis, and the LASSO method was used for optimal prediction. Subsequently, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative VTE in the training group, and a nomogram for predict risk of VTE was established. The discrimination, calibration, and clinical usefulness of the nomogram were separately evaluated using the C-index, receiver operating characteristic curve, calibration plot and clinical decision curve, and was validated using data from the validation group finally.ResultsMultivariate logistic regression analysis identified 10 independent risk factors for VTE after spinal surgery. A nomogram was established based on these independent risk factors. The C-index for the training and validation groups indicating high accuracy and stability of the model. The area under the receiver operating characteristic curve indicating excellent discrimination ability; the calibration curves showed outstanding calibration for both the training and validation groups. Decision curve analysis showed the clinical net benefit of using the nomogram could be maximized in the probability threshold range of 0.01–1.ConclusionPatients undergoing spinal surgery with elevated D-dimer levels, prolonger surgical, and cervical surgery have higher risk of VTE. The nomogram can provide a theoretical basis for clinicians to prevent VTE.

Venous Thromboembolism in Total Hip and Total Knee Arthroplasty

The optimal pharmacologic thromboprophylaxis agent after total hip and total knee arthroplasty is uncertain and consensus is lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) and bleeding and evaluating comparative effectiveness and safety of the thromboprophylaxis strategies can inform care. To quantify risk factors for postoperative VTE and bleeding and compare patient outcomes among pharmacological thromboprophylaxis agents used after total hip and knee arthroplasty. This retrospective cohort study used data from a large health care claims database. Participants included patients in the United States with hip or knee arthroplasty and continuous insurance enrollment 3 months prior to and following their surgical procedure. Patients were excluded if they received anticoagulation before surgery, received no postsurgical pharmacological thromboprophylaxis, or had multiple postsurgery thromboprophylactic agents. In a propensity-matched analysis, patients receiving a direct oral anticoagulant (DOAC) were matched with those receiving aspirin. Aspirin, apixaban, rivaroxaban, enoxaparin, or warfarin. The primary outcome was 30-day cumulative incidence of postdischarge VTE. Other outcomes included postdischarge bleeding. Among 29 264 patients included in the final cohort, 17 040 (58.2%) were female, 27 897 (95.2%) had inpatient admissions with median (IQR) length of stay of 2 (1-2) days, 10 948 (37.4%) underwent total hip arthroplasty, 18 316 (62.6%) underwent total knee arthroplasty; and median (IQR) age was 59 (55-63) years. At 30 days, cumulative incidence of VTE was 1.19% (95% CI, 1.06%-1.32%) and cumulative incidence of bleeding was 3.43% (95% CI, 3.22%-3.64%). In the multivariate analysis, leading risk factors associated with increased VTE risk included prior VTE history (odds ratio [OR], 5.94 [95% CI, 4.29-8.24]), a hereditary hypercoagulable state (OR, 2.64 [95% CI, 1.32-5.28]), knee arthroplasty (OR, 1.65 [95% CI, 1.29-2.10]), and male sex (OR, 1.34 [95% CI, 1.08-1.67]). In a propensity-matched cohort of 7844 DOAC-aspirin pairs, there was no significant difference in the risk of VTE in the first 30 days after the surgical procedure (OR, 1.14 [95% CI, 0.82-1.59]), but postoperative bleeding was more frequent in patients receiving DOACs (OR, 1.36 [95% CI, 1.13-1.62]). In this cohort study of patients who underwent total hip or total knee arthroplasty, underlying patient risk factors, but not choice of aspirin or DOAC, were associated with postsurgical VTE. Postoperative bleeding rates were lower in patients prescribed aspirin. These results suggest that thromboprophylaxis strategies should be patient-centric and tailored to individual risk of thrombosis and bleeding.

P144. The effect of operative duration on postoperative VTE rates in spinal surgery

<h3>BACKGROUND CONTEXT</h3> The relationship between operative duration and its effect on postoperative venous thromboembolism (VTE) remains unclear in spine surgery. Previous studies have been limited in cohort size or have lacked adequate variability of surgical duration to determine the extent of effect surgery length has on VTE rates. Information regarding patient demographics and the effect of surgical durations on VTE are critical to establish appropriate guidelines for determining which patients could benefit from postoperative chemoprophylaxis. <h3>PURPOSE</h3> To determine the effect of operative duration on postoperative VTE rates in patients undergoing elective thoracolumbar spinal procedures. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients >18 years of age who underwent thoracolumbar spinal fusion between 2007-2021 were retrospectively identified. A 10:1 propensity match incorporating patient demographics and surgical characteristics was conducted to match and compare patients for postoperative VTE events. <h3>OUTCOME MEASURES</h3> Postoperative VTE events, cut-to-close duration, prior history of clots, Oswestry Disability Index (ODI), Mental (MCS-12) and Physical (PCS-12) Component Summary of the Short-Form 12, visual analog scale (VAS) Back, VAS Leg. <h3>METHODS</h3> A structured query language (SQL) search was used to identify patients who underwent a thoracolumbar surgery and had a postoperative VTE. Only patients with deep VTEs were included. Demographics, surgical characteristics and patient reported outcome measures (PROMs) were collected from the electronic medical record. Patients were categorized into a VTE and non-VTE group. Categorical comparisons were analyzed using Pearson chi-square analysis or Fisher's Exact test. Continuous variables were analyzed using independent samples t-test or Mann-Whitney U test. A binary logistic regression was then performed to determine if cut-to-close duration was a predictor of increased postoperative VTE events—controlling for demographics and a history of clots. A receiver operating characteristic (ROC) curve using Youden's index was created to determine a "cutoff" time for predicting increased likelihood of a VTE based on surgical duration. <h3>RESULTS</h3> A total of 1,456 patients (122 VTE, 1,334 non-VTE) were included. The VTE group was younger (61.5 vs 65.5, p<0.001), predominantly male (60.8% vs 44.5%, p=0.001), experienced a previous VTE (15.6% vs 2.92%, p<0.001) and had higher cut-to-close time (304 mins vs 209 mins, p<0.001). However, there was no difference in CCI between groups (1.08 vs 0.66, p=0.119). When evaluating PROMs, the VTE group had worse 1-year postoperative minus preoperative (∆) ODI (-11.79 vs -21.99, p=0.039), ∆PCS-12 (4.30 vs 8.52, p=0.045), and ∆VAS Leg (-1.41 vs -4.08, p=0.001). Operative duration was an independent predictor of increased postoperative VTE rates on bivariate regression analysis (β=0.01, p<0.001). When evaluating the ROC, a cutoff time of 245 mins was identified (AUC [95% CI] = 0.672 [0.615 – 0.728]) as an optimal predictor of increased risk for a VTE. <h3>CONCLUSIONS</h3> A history of a prior VTE was associated with greater VTE rates during elective thoracolumbar surgery. Patients with a VTE had worse 1-year ∆ODI, ∆PCS-12, and ∆VAS Leg indicating that patients have worse overall improvement after VTE development, even after the VTE has been treated. Additionally, a higher operative duration is an independent risk factor for postoperative VTE. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Poster 222: Venous Thromboembolism Risk factors and Prophylaxis Patterns in Knee Arthroscopy: A Large Database Study

Objectives:Incidence of venous thromboembolism (VTE) after knee arthroscopy is reportedly low, but rates vary significantly across literature. Current guidelines recommend against routine perioperative thromboprophylaxis, but prescribing practices and VTE risk factors are poorly understood.Methods:Medical records for patients ≥18 years of age were queried from the Pearl Diver database using CPT codes for arthroscopic knee procedures. Patients with a previous diagnosis of VTE or hyper-coagulable disorder were excluded from analyses. Procedures were grouped by rehabilitation protocols, with restrictive procedures requiring a period of non-weightbearing or postoperative immobilization. Patients who received perioperative thromboprophylaxis were identified. Patients diagnosed with VTE, including pulmonary embolism and/or deep vein thrombosis, within 90 days of surgery were identified using International Classification of Diseases (ICD) codes. Multivariable logistic regression models were utilized to identify VTE risk factors and likelihood of thromboprophylaxis prescription. Covariates included age, restrictive rehabilitation protocols, oral contraceptive pill (OCP) use, and medical comorbidities.Results:A total of 718,289 patients underwent knee arthroscopy from 2011 to 2020. 10,769 patients (1.5%) received perioperative thromboprophylaxis, including aspirin (n=5,353, 0.7%), low molecular weight heparin (n=4,563, 0.6%) and factor Xa inhibitors (n=947, 0.1%). A total of 7,618 patients (1.1%) experienced VTE. Perioperative prophylaxis was associated with decreased odds of experiencing VTE (adjusted odds ratio [aOR] = 0.64, 95% confidence interval [CI] = 0.51 to 0.79) (Table 1). Restrictive procedure type was associated with increased odds of experiencing VTE (aOR =1.42, 95% CI = 1.34 to 1.50) and receiving prophylaxis (aOR=1.95, 95% CI = 1.87 to 2.05). OCP use (aOR = 1.63, 95% CI = 1.37 to 1.91), renal disease (aOR = 1.33, 95% CI = 1.18 to 1.50) and congestive heart failure (aOR = 1.30, 95% CI = 1.13 to 1.49) were associated with increased odds of VTE. Tobacco use was associated with increased odds of VTE (aOR = 1.12, 95% CI 1.03 to 1.22), but decreased odds of receiving perioperative prophylaxis (aOR = 0.84, 95% CI 0.78 to 0.91). Malignancy was associated with increased odds of receiving prophylaxis (aOR = 1.18, 95% CI 1.09 to 1.29) but not with increased odds of VTE.Conclusions:Procedures with restrictive rehabilitation protocols, OCP use, renal disease, and congestive heart failure are associated with increased odds of VTE following knee arthroscopy. Conversely, the use of perioperative thromboprophylaxis is associated with significantly lower odds of VTE. Risk factors for postoperative VTE are not always correlated with increased likelihood of receiving perioperative thromboprophylaxis. Patients with a tobacco use history may be an at-risk population that can be better selected for thromboprophylaxis when clinically appropriate.Table 1.Multivariable Logistic Model of VTE and Perioperative Thromboprophylaxis Odds

Prevalence and Risk Factors for the Development of Venous Thromboembolism After Spinal Tumor Surgery

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is a deleterious complication that can be fatal. However, the prevalence and underlying risk factors for VTE after spinal tumor surgery remain poorly defined. Ninety-six patients undergoing spinal tumor surgery with postoperative screening for DVT and PTE were reviewed. We evaluated the relationship between postoperative VTE and the following factors: age, sex, height, weight, body mass index, location of the tumor, type of tumor (primary or metastasis), type of operation (excisional surgery or palliative surgery), surgical approach (posterior or combined), operative time, intraoperative blood loss, perioperative transfusion, amount of transfusion, duration of postoperative bed rest (<7days or >7days), preoperative paralysis, postoperative paralysis, and postoperative neurological worsening. The overall prevalence of VTE was 25.0% (24/96). The rate of DVT and PTE was 20.8% (20/96) and 6.3% (6/96), respectively. PTE only was identified in 4 of 6 PTE-positive patients, and both PTE and DVT were identified in 2. In univariate analysis, the duration of postoperative bed rest of the VTE group was significantly longer than that of the non-VTE group (P= 0.03). In multivariate analysis, only prolonged duration of postoperative bed rest was a significant independent risk factor (P= 0.036). The prevalence of VTE after spinal tumor surgery was 25.0%. Prolonged duration of postoperative bed rest was a risk factor for postoperative VTE. No DVT was found in 4 of 6 PTE-positive patients, suggesting that screening for PTE itself is also needed in high-risk cases of VTE.

Neoadjuvant Treatment and the Prolonged Risk of Venous Thromboembolism in Resectable Pancreatic Cancer

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is one of the most thrombogenic cancers and PDAC-patients are at 12-19% risk of venous thromboembolism (VTE). Chemotherapy is one of the risk factors for VTE. We aimed to investigate the relation between neoadjuvant treatment (NAT) and postoperative VTE in PDAC by comparing NAT patients with upfront surgery (US) patients. Method: PDAC-patients surgically treated in Helsinki University Hospital 2006-2017 were identified (n=492). Following data were collected: VTE, BMI, age, neoadjuvant and adjuvant treatment, medication, tumor size, positive lymph node ratio, perivascular- and perineural invasion, vascular reconstruction, and other cancers. The follow-up was at least 2 years or until death. Patients with another cancer, immediate death postoperatively, inoperable disease, lack of monitoring data, and coagulation disorders were excluded (n=108). Results: 384 patients were analyzed. Overall incidence of postoperative VTE was higher in NAT patients compared to US (n=28 (30.1%) vs. n=59 (20.3% p=0.049)). NAT was a significant risk factor for postoperative VTE: HR 1.61 (p=0.037) for two years after surgery (Figure). The significance was also seen in multivariate analysis (HR 1.74 p=0.025). In overall survival analysis VTE was a significant risk factor in both the NAT (HR 3.25 p<0.001) and US groups (HR 2.91 p<0.001). Characteristics associated with VTE in the NAT group were BMI>30 and disease recurrence. Conclusion: NAT is an independent risk factor for postoperative VTE in PDAC for up to two years. VTE is associated with increased mortality in the US and the NAT patients. Obesity and disease recurrence are associated with VTE.

Analysis of incidence and risk factors for postoperative venous thromboembolism in patients with stageⅠ a non-small-cell lung cancer

Objective: To analyze the incidence and risk factors for postoperative venous thromboembolism(VTE) in patients with stage Ⅰa non-small-cell lung cancer(NSCLC), so as to find evidence for further research of prophylactic anticoagulation. Methods: A total of 132 patients with stage Ⅰa NSCLC, 42 males and 90 females aged from 26 to 79 years with an average of (57±10) years, were retrospectively included in this study. All of them underwent surgical treatment at the Department of Thoracic Surgery of Beijing Chaoyang Hospital Affiliated with Capital Medical University from January 2017 to October 2020. A lower extremity venous ultrasound was performed before and after the operation. Participants were divided into VTE group (n=11) or non-VTE group (n=121) according to whether or not VTE occurred after operation. The surgical conditions, test indicators, imaging information, pathology information were compared between the two groups. Logistic regression analysis was performed to test the associations of VET with putative risks factors in which significant differences were observed. The independent risk factors of VET were determined by this way. Results: Postoperative VTE occurred in 11 cases (8.3%), including 10 cases (90.9%) of deep vein thrombosis (DVT) of lower limbs and 1 case (9.1%) of DVT complicated with pulmonary embolism (PE). The mean age of Patients in the VTE group was older than that in non-VTE Group ((65±9) years vs (57±10) years, P=0.009). On the fifth day after operation, patients in both groups had significantly higher D-dimer level compared with that before operation (3.18(1.55, 5.15) vs 1.54(1.09, 2.57); 2.66(1.17, 4.65) vs 1.34(0.78, 2.04))(both P<0.05). The value of neuron-specific enolase (NSE) and the number of lymph nodes removed during the operation in the VTE group were significantly higher than those in the non-VTE group ((21.54±12.37) vs (14.72±5.75); (19.7±8.2) vs (13.0±7.9)) (both P<0.05). There was no statistically significant difference in the approach of surgery, imaging features (tumor location, vascular cluster signs, etc.), and pathological information (pathological types, etc.) (all P>0.05). The logistic regression analysis showed that the number of lymph nodes removed during the operation was an independent risk factor related to the occurrence of VTE (OR=1.306, 95%CI:1.000-1.600,P<0.05). Conclusions: The incidence of postoperative VTE in patients with stage Ⅰa NSCLC is approximately 8.3%. The number of lymph nodes removed during the operation may be an independent risk factor for postoperative VTE in patients with stage Ⅰa NSCLC.

Venous thromboembolism: risk factors in the sleeve gastrectomy era.

Of complications after bariatric surgery, venous thromboembolism (VTE) has the greatest impact on mortality. To examine risk factors for postoperative VTE and identify high-risk patients who may benefit from prolonged prophylaxis. National Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database METHODS: Patients who underwent primary, laparoscopic bariatric surgery 2015-2019 were identified. Risk factors were sex, age, body mass index (BMI), history of VTE, immobility, venous stasis disease, operative time greater >3 hours, and procedure type. Multivariable logistic regression was used to examine associations between factors and the outcome of postoperative VTE. We examined contributions of each factor through average marginal effects and E-values. We added Black versus White race to the same regression model to understand whether race acted as a moderating factor. In our study, 1677 of 605,782 (.28%) patients experienced postoperative VTE. On multivariable analysis, previous history of VTE had the greatest association, increasing risk of postoperative VTE by +.90% points (95% CI [confidence interval] +.73% to +1.07%). Lower-95% CI E-value bounds were 1.43 for men, 1.11 preoperative BMI, 7.38 history of VTE, and 2.15 operative length >3 hours. Black patients had an additional +.18% (95% CI +.14 to +.22%) risk of postoperative VTE, corresponding to a lower E-value bound of 2.50. In this study using recent years' national bariatric surgery data, we find history of VTE is the greatest driver of postoperative VTE. Most importantly, Black patients are more likely to suffer postoperative VTE. Now is the time to use the power of quality improvement programs to ensure health equity for all our patients.

228. Complications following posterior cervical arthrodesis for cervical spondylotic myelopathy: a single institution's experience

<h3>BACKGROUND CONTEXT</h3> Posterior cervical fusion (PCF) is a frequently performed surgery for treatment of cervical spondylotic myelopathy (CSM). While incidences of these risks have been reported previously, prior studies on this topic either contain small sample sizes, pooled from multiple institutional or public databases, or have low follow-up duration. Here, we report the incidence of postoperative complications following PCF for CSM at a single institution with a large patient cohort. To review the rate of postoperative complications following primary posterior cervical fusion for cervical CSM at a single institution. <h3>PURPOSE</h3> To review the rate of postoperative complications following primary posterior cervical fusion for CSM at a single institution. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series, single institution. <h3>METHODS</h3> Patients with a diagnosis of CSM treated with PCF over a 4-year period at a tertiary care center were identified. Exclusion criteria included: (1) cervical myelopathy secondary to trauma, spinal infection, or spinal neoplasm, (2) fusion constructs that proximally included occiput or C1, or distally extended below T2, and (3) revision PCF procedures. Postoperative data collected included incidence of superficial surgical site infection (SSI), deep wound infection, subsequent irrigation and debridement (I&D), postoperative pneumonia, venous thromboembolism (VTE), epidural hematoma, and C5 nerve palsy during course of follow-up. Multivariable regression analyses were performed to identify patient characteristics and comorbidities that were independent risk factors for these complications. <h3>RESULTS</h3> A total of 176 patients met inclusion criteria (mean age + standard deviation = 63.8 + 11.1 years). An average of four levels (range: 1-7) were fused per surgery. Mean follow-up was one year. Of 176 patients, 33 (18.7%) had at least one documented postoperative complication. There were six cases (3.4%) of superficial SSI and four cases (2.3%) of deep wound infection. One patient (0.57%) developed a postoperative epidural hematoma. There were five cases (2.8%) of VTE and six cases (3.4%) of postoperative pneumonia. Fifteen patients (8.5%) developed C5 nerve palsy, of which 12 of 15 cases were transient and improved. Diabetes was an independent risk factor for postoperative VTE (p=0.03) and pneumonia (p=0.03). <h3>CONCLUSIONS</h3> Almost 1 in 6 patients had some complication after posterior cervical fusion for treatment of CSM. The incidence of C5 nerve palsy at 8.5% was not trivial. Though PCF is a routine procedure, our results highlight the need for appropriate preoperative counseling, especially in patients with diabetes mellitus. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Postoperative venous thromboembolism in gynecologic oncology patients undergoing minimally invasive surgery: does modality matter?

<h3>Objectives:</h3> Minimally invasive surgery (MIS) is increasingly utilized for gynecologic cancers. While rates of venous thromboembolism (VTE) after MIS are low overall, risk factors such as malignancy and prior pelvic surgery may increase risk of perioperative VTE. Various guidelines exist regarding extended chemoprophylaxis with low molecular weight heparin (LMWH) for VTE prevention. Our objective was to determine incidence of 30-day postoperative VTE in patients undergoing MIS for gynecologic malignancies and to determine differences in the incidence of VTE by MIS modality. <h3>Methods:</h3> We collected demographic and perioperative variables for all patients undergoing MIS (robot-assisted, multi-port laparoscopy, single-port laparoscopy) for gynecologic cancers between January 2014 and December 2018. Patients <18 years, with benign pathology, or on preoperative anticoagulation were excluded. Logistic regression, Chi-square, Fisher's exact test, and one-way ANOVA were performed to determine risk factors related to VTE occurrence. <h3>Results:</h3> We identified 818 patients who underwent MIS (median age 61, 97% non-Hispanic White, mean BMI 34 kg/m²). Most had Stage I disease (81.4%) and uterine cancer (81.6%). 99.9% received intraoperative unfractionated heparin (UFH) and 96.6% received immediate postoperative UFH. Three VTE events occurred within 30 days following surgery (0.3%). Twelve patients received extended chemoprophylaxis with LMWH (1.5%); 11 patients received a 28-day course while one patient received a 14-day course. VTE was diagnosed in a total of 17 patients within 18 months of surgery (2%, median time to VTE 12 months). Of those diagnosed with VTE, 11 patients underwent robot-assisted laparoscopy, 4 patients underwent multi-port laparoscopy and 2 patients underwent single-port laparoscopy. Incidence of VTE did not differ between MIS modalities (<i>p</i>=0.6). Patients with Stage III disease (<i>p</i><0.001) and longer operative time (<i>p</i>=0.04) were more likely to experience postoperative VTE. Age, smoking status, BMI, and cancer type were not significant risk factors for postoperative VTE. <h3>Conclusions:</h3> The incidence of postoperative VTE in patients with gynecologic cancers undergoing MIS is low and does not differ by modality. Extended chemoprophylaxis is unlikely to be beneficial in patients with gynecologic malignancies undergoing MIS procedures.

Coagulopathy and Venous Thromboembolic Events Following Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

BackgroundCoagulopathy after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is recognized but few details have been studied.ObjectivesThe aim of this study was to investigate changes in coagulation biomarkers and their predictive ability for venous thromboembolism (VTE).MethodsPatients undergoing CRS and HIPEC at Uppsala University Hospital, Sweden, from 2004 to 2014 were included in a prospective study of coagulation biomarkers. Prothrombin time international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, D-dimer, and platelets were sampled on postoperative days 1, 2, 5, and 10. Logistic regression analysis was used to evaluate predictive capacity for coagulation-related complications.ResultsOverall, 380 patients were included (214 females, mean age 56 years); 38 patients had a history of thromboembolism and 57 were active smokers. Mean perioperative blood loss was 1228 mL and 231 (61%) received perioperative blood transfusions. PT-INR and APTT were elevated directly after surgery but returned to normal levels on postoperative day 5. Conversely, fibrinogen, platelet count, D-dimer, and antithrombin increased by postoperative day 5 and continued to increase up to day 10. There were 23 radiologically verified cases of VTE within 6 months. The multivariate analysis identified a completeness of cytoreduction score of 2–3 (p = 0.047) and day 2 D-dimer (p = 0.0082) as independent risk factors for postoperative VTE.ConclusionSignificant postoperative changes in coagulation biomarkers occur with dynamic changes over 10 days postoperatively. The incidence of symptomatic VTE was low. Residual tumor at completion of surgery and elevated D-dimer on day 2 were independent risk factors for postoperative VTE.

Which orally administered antithrombotic agent is most effective for preventing venous thromboembolism after total knee arthroplasty? A propensity score-matching analysis

PurposeEven today, total knee arthroplasty (TKA) is associated with venous thromboembolism (VTE). The purpose of our study is to report the incidence of postoperative VTE and to compare the efficacy of commonly used orally administered antithrombotic agents.Materials and methodsSeven hundred ad ninety-nine patients who underwent primary TKA were retrospectively reviewed. The patients were prescribed one of three antithrombotic agents: aspirin (n = 168), rivaroxaban (n = 117), or apixaban (n = 514). Before surgery, patient demographics and risk factors were matched via propensity scoring. After surgery, all three groups took the agent for 7 days and underwent ultrasonography to check for VTE.ResultsThe overall incidence of postoperative VTE was 15.4% (123/799). Only one patient developed symptomatic VTE. Female sex and staged bilateral TKA were risk factors for postoperative VTE. The postoperative VTE rates in the aspirin, rivaroxaban, and apixaban groups were 16.2%, 6.0%, and 17.1%, respectively, significantly lower in the rivaroxaban group (p < 0.02). The majority of VTEs in all three groups were calf-vein thromboses.ConclusionsAll agents showed enough efficacy as antithrombotic agents. Considering that aspirin is inexpensive, aspirin is a cost-effective option for preventing postoperative VTE.

Clinical analysis of postoperative venous thromboembolism in Japanese patients after colorectal cancer surgery.

Venous thromboembolism (VTE) is a major complication after abdominal surgery; however, the best strategy for preventing VTE after surgery is not yet established. We performed this study to investigate the incidence of perioperative VTE and evaluate the efficacy of a VTE preventive strategy for patients undergoing surgery for colorectal cancer (CRC). The subjects of this retrospective analysis were 228 patients who underwent curative surgical resection for CRC between 2012 and 2016. The patients were treated with thromboprophylaxis including enoxaparin. We assessed the perioperative VTE occurrence rate and investigated the risk factors for postoperative VTE. Among the 228 patients, 77 had a preoperative D-dimer level of > 1.0μg/mL and 12 had deep vein thrombosis (DVT) diagnosed by ultrasonography preoperatively. Of the remaining 216 patients, short-term VTE (< 30days) developed in two patients (0.9%) and long-term VTE (30days-3years) developed in seven (3.2%). The mortality rate of patients with VTE was 0%. The univariate analysis indicated that pulmonary disease was the risk factor for short-term VTE, whereas obesity, hyperlipidemia, and a preoperative history of pulmonary embolism were the risk factors for long-term VTE (p < 0.05). The findings of this analysis show that our preventive protocol including enoxaparin is an effective strategy for preventing postoperative VTE.

Incidence of venous thromboembolism and bleeding after pulmonary lobectomy: evaluating the timing for thromboprophylaxis

Venous thromboembolism (VTE) is an important postoperative complication after major lung cancer resective surgery, such as lobectomy. It is recommended to start chemical thromboprophylaxis within the first 12 h following the procedure. Postoperative bleeding is also a relevant complication in patients with predisposing conditions. However, the criterion for classifying a patient as "high risk of bleeding" is not standardized and is left to the expertise of the attending physician or surgeon. We aim to describe the incidence and risk factors for postoperative VTE and hemorrhage after pulmonary lobectomy; and to assess the impact of the timing of thromboprophylaxis on the incidence of postoperative thrombotic or hemorrhagic events. A retrospective observational study of 358 lobectomies performed in a single center was performed, analyzing the rates of postoperative thrombotic and hemorrhagic events and predisposing factors, including postoperative thromboprophylaxis management. Cumulative incidence of VTE was 3.07% (95% CI 1.54-5.43), and early postoperative bleeding was 10.05% (95% CI 7.14-13.64). Underlying pulmonary disease was associated with VTE (p = 0.001) and open approach was associated with hemorrhagic events (p = 0.01). The use of thromboprophylaxis and timing of its initiation were not associated with a higher incidence of events. VTE and postoperative hemorrhage are relevant complications following pulmonary lobectomy. Compliance with VTE prophylaxis guidelines is essential. Even so, a case-by-case risk evaluation of VTE and bleeding remains preferable and safe in order to decide on the most suitable timing of thromboprophylaxis.

Postoperative Venous Thromboembolism in Extramedullary Spinal Tumors.

Context:Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), is the fatal complication following spine surgery and the appropriate perioperative prophylaxis is still debated.Aims:The aim of this study is to evaluate the incidence of along with risk factors for postoperative VTE in surgically treated extramedullary spinal tumor patients.Setting and Designs:The study design involves single institute and retrospective cohort study.Subjects and Methods:The cohort database was reviewed between the periods of January 2014 and June 2019. Patients undergoing surgery for spine tumor, extradural tumor, and intradural extramedullary were consecutively collected.Statistical Analysis Used:The incidence of VTE and clinical factors reported to be associated with VTE were identified, and then analyzed with an appropriate Cox regression model.Results:The study identified 103 extramedullary spinal tumor patients. Three patients (2.9%) were diagnosed with a proximal leg DVT, while symptomatic PE did not identify. Risk factors associated with DVT occurrence were as follows: operative time ≥8 h (Hazard ratio [HR] 13.98, P = 0.03) and plasma transfusion (HR 16.38, P = 0.02), whereas plasma transfusion was the only significant factor, after multivariate analysis (HR 11.77, P = 0.05).Conclusions:Patients who underwent surgery for extramedullary spinal tumors showed a 2.9% incidence of DVT. The highest rate of DVT was found in patients who received plasma transfusion. More attention should be paid on perioperative associated factors for intensive prevention coupled with early screening in this group.

The incidence of venous thromboembolism in children following colorectal resection for inflammatory bowel disease: A multi-center study

Background/PurposeChildren with inflammatory bowel disease (IBD) have increased risk for venous thromboembolism (VTE). We sought to determine incidence and risk factors for postoperative VTE in a multicenter cohort of pediatric patients undergoing colorectal resection for IBD. MethodsRetrospective review of children ≤18 years who underwent colorectal resection for IBD from 2010 to 2016 was performed at four children's hospitals. Primary outcome was VTE that occurred between surgery and last follow-up. Factors associated with VTE were determined using univariable and multivariable analyses. ResultsTwo hundred seventy-six patients were included with median age 15 years [13,17]. Forty-two children (15%) received perioperative VTE chemoprophylaxis, and 88 (32%) received mechanical prophylaxis.DVT occurred in 12 patients (4.3%) at a median of 14 days postoperatively [8,147]. Most were portomesenteric (n = 9, 75%) with the remaining catheter-associated DVTs in extremities (n = 3, 25%).There was no association with chemoprophylaxis (p > 0.99). On Cox regression, emergent procedure [HR 18.8, 95%CI: 3.18–111], perioperative plasma transfusion [HR 25.1, 95%CI: 2.4–259], and postoperative infectious complication [HR 10.5, 95%CI: 2.63–41.8] remained predictive of DVT. ConclusionLess than 5% of pediatric IBD patients developed postoperative VTE. Chemoprophylaxis was not protective but rarely used. Patients with risk factors identified in this study should be monitored or given prophylaxis for VTE. Level of EvidenceTreatment Study, Level III.

Potential Risk Factors Contributing to Development of Venous Thromboembolism for Total Knee Replacements Patients Prophylaxed With Rivaroxaban: A Retrospective Case-Control Study.

Rivaroxaban after total knee arthroplasty (TKA) is used to prevent postoperative venous thromboembolism (VTE); however, despite thromboprophylaxis, some patients still develop postoperative VTE. To determine whether tourniquet time, time to initiate rivaroxaban (TTIRIV), or Body Mass Index (BMI) was associated with postoperative VTE. A retrospective case-control study was conducted. Those patients that developed VTE despite prophylaxis (cases) were compared to controls (no VTE). A univariate analysis was conducted (p < 0.05 statistically significant). Seven VTE cases were identified from 234 TKA-patients. Patients with and without VTE had BMI of 40.1 ± 9.1 and 32.8 ± 7.5, respectively (p = 0.064). TTIRIV in VTE and control group was 28.2 ± 4.7 hours and 26.4 ± 4.2 hours, respectively (p = 0.39). Mean tourniquet time in VTE and control group was 65.0 ± 8.7 minutes and 49 ± 8.8 minutes, respectively (p = 0.0007). Statistically significant differences in tourniquet times were noted between VTE and non-VTE group but not for TTIRIV and BMI. Prolonged tourniquet use could pose a potential risk factor for postoperative VTE. Thromboprophylaxis management may need to be adjusted, based on patient-specific factors that could include increasing doses of oral anticoagulants and/or mechanical prophylaxis. However, further large-scale studies are required to establish pathophysiology.

The EGFR-rearranged adenocarcinoma is associated with a high rate of venous thromboembolism.

The purpose of this study was to investigate the incidence of venous thromboembolism (VTE) in epidermal growth factor receptor (EGFR) mutations patients with lung adenocarcinoma, to provide clinical basis for the perioperative prevention and treatment of VTE in patients with lung cancer. This study included patients with invasive lung adenocarcinoma confirmed by pathology from July 2016 to March 2018 after surgical pulmonectomy in Thoracic Surgery Department of Beijing Chaoyang Hospital. All enrolled patients were tested for relevant gene mutations. All patients were classified as adenocarcinoma subtypes by the 2011 International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS) and European Respiratory Society (ERS). Patients were divided into the VTE group and the control group according to whether VTE occurred postoperatively. Baseline data, gene test results, operative data and tumor pathology data between the two groups were compared. According to the inclusion criteria, a total of 323 patients underwent lung cancer surgery were analyzed in this study, including 148 males and 175 females, aged from 25 to 82 years old. Postoperative VTE occurred in 33 patients, with an incidence of 10.2%. Compared the baseline data, there were significant differences in age and BMI between the two groups, but no significant differences in other indicators. Comparing the results of postoperative genetic tests, the cases of exon 18, 19, 20, 21, 30, 31 mutation, exon 18 and 20 mixed mutation and exon 20 and 21 mixed mutation were 5, 42, 6, 57, 1, 3, 1 and 1. The total EGFR mutation rate in the enrolled patients was 36.2% (117/323). Among them, the proportion of EGFR mutation in the VTE group was significantly higher than that in the non-VTE group (60.6% vs. 33.4%, P=0.002). Exon mutations in specific regions and mixed region of EGFR were not statistically significant between them; there was no statistical difference in the concomitant KRAS and ALK gene mutations between them. Comparing the pathological conditions, the proportion of acinar dominant lung adenocarcinoma in the VTE group was higher than that in the non-VTE group (57.6% vs. 30.7%, P=0.002); other histologic subtypes showed no statistical difference. The D-dimer difference before and 1 day after surgery, preoperative FEV1, surgical method, duration of surgery and blood loss were statistically significant differences between the two groups. The results of univariate analysis showed that there were significant differences between the VTE group and the control group in proportion of EGFR mutant lung adenocarcinoma, age, BMI, D-dimer difference before and 1 day after surgery, preoperative FEV1, surgical method, duration of surgery, blood loss and proportion of acinar dominant lung adenocarcinoma (P<0.05). However, VTE was not significantly correlated with gender, ALK or KRAS gene mutation and other factors. Multi-factor logistics regression analysis shows that Patients with EGFR gene mutation infiltrating lung adenocarcinoma, acinar dominant lung adenocarcinoma, FEV1 and difference of D-dimer (d1-pre) are independent risk factors for postoperative lung cancer complicated with VTE. The incidence of VTE was 10.2% in patients with invasive lung adenocarcinoma without prophylactic anticoagulant therapy. EGFR gene mutation is an independent risk factor for postoperative VTE in lung cancer, and the incidence of VTE in adenocarcinoma with alveolar predominance is the highest. Other independent risk factors included the difference of D-dimer (d1-pre) and preoperative FEV1.